System and method for providing mapping between different disease classification codes

ABSTRACT

A system for translating healthcare codes from a first healthcare classification system to a second healthcare classification system may receive a first plurality of healthcare codes associated with the first healthcare classification system, receive a second plurality of healthcare codes associated with the second healthcare classification system, and map at least one of the first plurality to at least one of the second plurality according to user-defined parameters.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of, and priority to, U.S. PatentApplication Ser. No. 61/834,908, filed Jun. 14, 2013, the disclosure ofwhich is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

This disclosure relates generally to a computerized system and methodfor healthcare-related data, and more specifically to a system andmethod for providing mapping between different disease classificationcodes such as between ICD-9 and ICD-10 code sets.

BACKGROUND

Healthcare legislation specifies procedures for communicatinginformation within the healthcare industry. For example, Title II(Administrative Simplification provisions) of the Health InsurancePortability and Accountability Act of 1996 (“HIPAA”) required theDepartment of Health and Human Services to establish national standardsfor electronic health care transactions and national identifiers forproviders, health plans, and employers.

On Jan. 1, 2012, an updated version of the healthcare transactionsstandard, HIPAA 5010, replaced version 4010A1, the current set ofstandards. Among various changes in this update, HIPAA 5010 mandateschanges to the International Classification of Diseases (“ICD”), whichis a nomenclature for the classification of diseases, injuries, andother medical conditions. More specifically, HIPAA 5010 requireshealthcare payers and providers to transition from the currentInternational Classification of Diseases, 9th Revision, ClinicalModification (“ICD-9”) to a 10th revision (“ICD-10”). This transition isreferred to herein as the “ICD-10 migration” and, at present, allhealthcare stakeholders (e.g., providers, payers, and employers), mustmake this transition by Oct. 1, 2015.

ICD-10 codes exhibit fundamental differences as compared with ICD-9codes. For example, the form and information conveyed in ICD-10 codes isdifferent than that of the ICD-9 codes. More specifically, ICD-9 codescontain three to five digits beginning with either a number or a letter,with a decimal point placed after the third digit, and the ICD-9 bookindicates the level of specificity for each code. ICD-10 codes, on theother hand, are seven digits in length. The first three digits of theICD-10 codes are similar to the ICD-9 codes, with a decimal point afterthe third digit. However, the digits that follow the decimal point havedifferent, specific meanings. For medical and surgical procedures, forexample, the digits that follow are specific to body part, surgicalapproach, and other qualifiers needed for billing. Similarly, the ICD-10codes that represent diagnosis codes also have seven digits.

The first three digits of ICD-10 codes are similar to the ICD-9 code,but the additional digits add specificity to the code such aslaterality, chronic versus acute, and so on. Another significantdifference between the ICD-9 and ICD-10 code sets is the number ofcodes. More specifically, ICD-9 includes just over 14,000 diagnosiscodes and almost 4,000 procedural codes. In contrast, ICD-10 containsover 68,000 diagnosis codes (clinical modification codes) and over72,000 procedural codes. Due to such fundamental differences, mapping ortranslation from the ICD-9 code set to the ICD-10 code set presentschallenges to ICD-10 migration. For example, while there are someone-to-one correspondences between ICD-9 and ICD-10 codes, there arealso one-to-many, many-to-one and many-to-many correspondences and, insome cases, no correspondence at all. Accordingly, ICD-10 migration willundoubtedly affect many aspects of information collection, reportingrequirements, billing and payment systems, potentially resulting inbenefit, financial and clinical variations.

SUMMARY

The present invention may comprise one or more of the features recitedin the attached claims, and/or one or more of the following features andcombinations thereof. In one aspect, a computerized method fortranslating healthcare codes from a first healthcare classificationsystem to a second healthcare classification system comprises receivinga first plurality of healthcare codes associated with the firsthealthcare classification system, receiving a second plurality ofhealthcare codes associated with the second healthcare classificationsystem, and mapping at least one of the first plurality to at least oneof the second plurality according to user-defined parameters.

In another aspect, a system comprises one or more computing devicesincluding a memory having program code stored therein, and a processorin communication with the memory for carrying out instructions inaccordance with the stored program code, wherein the program code, whenexecuted by the processor, causes the processor to perform stepscomprising receiving a first plurality of healthcare codes associatedwith the first healthcare classification system, receiving a secondplurality of healthcare codes associated with the second healthcareclassification system, and mapping at least one of the first pluralityto at least one of the second plurality according to user-definedparameters.

In yet another aspect, a computer program product comprisingnon-transitory computer readable medium further comprising code forreceiving a first plurality of healthcare codes associated with thefirst healthcare classification system, code for receiving a secondplurality of healthcare codes associated with the second healthcareclassification system, and code for mapping at least one of the firstplurality to at least one of the second plurality according touser-defined parameters.

BRIEF DESCRIPTION OF THE DRAWINGS

This disclosure is illustrated by way of example and not by way oflimitation in the accompanying FIGS. Where considered appropriate,reference labels have been repeated among the FIG.s to indicatecorresponding or analogous elements.

FIG. 1 is a simplified block diagram of an embodiment of a computerizedsystem that may be programmed with a set of instructions to perform anyone or more of the functions, processes and methods discussed herein.

FIG. 2 is a simplified block diagram representation of a diseaseclassification code mapping tool executed by the system illustrated inFIG. 1.

FIG. 3 is a simplified block diagram depicting an example architectureof the disease classification code mapping tool.

FIG. 4 is an example screen shot of a main page of the tool illustratinga process for selecting an application mode and business area in whichto operate the disease classification code mapping tool illustrated inFIGS. 2 and 3.

FIG. 5 is an example of a screen shot illustrating selection of aspecific application mode and a specific business area in which tooperate the disease classification code mapping tool illustrated inFIGS. 2 and 3.

FIG. 6 is an example of a screen shot illustrating a process forconfiguring the disease classification code mapping tool for mapping ofone particular disease classification code type to another particulardisease classification code type.

FIG. 7 is an example of a screen shot illustrating a process forconfiguring the disease classification code mapping tool for mapping ofyet another particular disease classification code type to furtherparticular disease classification code type.

FIG. 8 is an example screen shot illustrating a process for uploading aparticular disease classification code mapping file in a GEMsapplication mode of the disease classification code mapping tool.

FIG. 9 is an example screen shot illustrating a process for uploading aparticular disease classification code mapping file in a specificapplication mode of the disease classification code mapping tool for useby a financial neutrality analysis tool.

FIG. 10 an EXCEL™ file to which the disease classification code mappingfile is uploaded using the process illustrated in FIG. 9.

FIG. 11 is an example screen shot illustrating a process for extractingand appending disease classification codes not present in an uploadeddisease classification code mapping file.

FIG. 12 is an example screen shot illustrating a graphic user interfacefor customizing a disease classification code mapping file bysupplementing the code mapping file with extra disease classificationcodes received by the tool.

FIG. 13 is an example screen shot illustrating a disease classificationcode mapping customization process using the graphic user interface ofFIG. 12.

FIG. 14 is an example screen shot further illustrating the diseaseclassification code mapping customization process of FIG. 13.

FIG. 15 is an example screen shot further still illustrating the diseaseclassification code mapping customization process of FIGS. 13 and 14.

FIG. 16 is an example screen shot illustrating a process for resettingthe disease classification code customization process shown in FIGS.13-15.

FIG. 17 is an example screen shot illustrating a graphic user interfacefor adding search tags to specified disease classification search codes.

FIG. 18 is an example screen shot illustrating a process for addingsearch tags to specified disease classification search codes using thegraphic user interface illustrated in FIG. 17.

FIG. 19 is a screen shot illustrating a process for exporting diseaseclassification code mappings from the tool.

FIG. 20 is a screen shot further illustrating the process of FIG. 19,

FIG. 21 is a screen shot further still illustrating the process of FIGS.19 and 20.

FIG. 22 is an example of an exported disease classification code mappingusing the process illustrated in FIGS. 19-21.

FIG. 23 is a screen shot illustrating a process for tagging diseaseclassification codes with one or more skill sets.

FIG. 24 is a screen shot further illustrating the process of FIG. 23.

FIG. 25 is a screen shot illustrating a process for updating sill setsof medical coders and approvers.

FIG. 26 is a screen shot illustrating a process for creating tasks forspecific users of the tool.

FIG. 27 is a screen shot illustrating a process for updating a diseaseclassification code list internal to the tool with a received diseaseclassification code list.

FIG. 28 is a screen shot further illustrating the process of FIG. 27.

FIG. 29 is a screen shot illustrating another process for updating adisease classification code list internal to the tool with a receiveddisease classification code list.

FIG. 30 is a screen shot further illustrating the process of FIG. 29.

FIG. 31 is a screen shot illustrating a process for forward mappingICD-9 codes to ICD-10 codes.

FIG. 32 is a screen shot further illustrating the process of FIG. 31.

FIG. 33 is a screen shot illustrating a look-up process for searchingdisease classification codes by code number.

FIG. 34 is a screen shot illustrating a look-up process for searchingdisease classification codes by description keyword.

FIG. 35 is a screen shot illustrating a graphic user interface forviewing disease classification code mapping confirmation histories.

FIG. 36 is a screen shot illustrating a process for confirming andrejecting selected disease classification code mappings.

FIG. 37 is a screen shot illustrating a process for inputting start andend dates of, and reasons for, confirmations of selected diseaseclassification code mappings.

FIG. 38 is a screen shot illustrating an example email messageautomatically generated and sent to one or more users of the toolinforming confirmation or rejection of selected disease classificationcode mappings.

FIG. 39 is a screen shot illustrating a process for backward mappingICD-10 codes to ICD-9 codes.

FIG. 40 is a screen shot illustrating a process for identifyingreimbursement equivalent ICD-9 codes of selected ICD-10 codes.

FIG. 41 is a screen shot illustrating a process for identifying similarforward and/or backward mappings of selected disease classificationcodes.

FIG. 42 is a screen shot illustrating a process for identifying businessareas in which selected ICD-9 codes have been confirmed.

FIG. 43 is a screen shot illustrating a graphic user interface forviewing mappings of selected ICD-9 codes across all business areas inwhich they are confirmed.

FIG. 44 is a screen shot illustrating a process for bulk confirmingselected one to one disease classification code mappings.

FIG. 45 is a screen shot illustrating a process for inputting start andend dates of, and reasons for, bulk confirmations of selected one to onedisease classification code mappings.

FIG. 46 is a screen shot illustrating a process for identifying mappingpercentages of selected categories of disease classification codemappings.

FIG. 47 is a screen shot of an example graphic user interface forviewing the ICD-9 to ICD-10 mappings of selected categories of diseaseclassification codes produced by the process of FIG. 46.

FIG. 48 is screen shot illustrating a process for identifying mappingpercentages of selected sections of disease classification codemappings.

FIG. 49 is a screen shot illustrating a report produced by the toolwhich tracks changes in disease classification code mappings across aselected date range.

FIG. 50 is a screen shot illustrating a graphic user interface forviewing mapping history details of individual disease classificationcodes identified by the report of FIG. 49.

FIG. 51 is a screen shot illustrating an example mapping distributionreport produced by the tool which shows percentages of diseaseclassification codes across a plurality of different diseaseclassification code categories for a specified business area and aspecified disease classification code type.

FIG. 52 is a screen shot illustrating an example mapping distributionreport produced by the tool which shows percentages of diseaseclassification codes across a plurality of different categories ofconfirmed disease classification codes for a specified business area anda specified disease classification code type.

FIG. 53 is a screen shot illustrating an example mapping distributionreport produced by the tool which shows details of individual diseaseclassification codes identified in the report of FIG. 51.

FIG. 54 is a screen shot illustrating an example report exported fromthe tool that includes details of individual disease classificationcodes in a sub-category of the disease classification code categoriesidentified in the report of FIG. 51.

FIG. 55 is a screen shot illustrating a graphic user interface forgenerating a mapping report of specified, confirmed diseaseclassification code mappings other than reimbursement mappings.

FIG. 56 is a screen shot illustrating a graphic user interface forgenerating a mapping report of specified, confirmed diseaseclassification code mappings across different business areas.

FIG. 57 is a screen shot illustrating a report generated by the graphicuser interface illustrated in FIG. 56.

FIG. 58 is a screen shot illustrating a graphic user interface forgenerating a mapping version report, along with an example such report,showing version change histories of disease classification code mappingsfor specified disease classification codes.

FIG. 59 is a screen shot illustrating a report generated by the toolwhich shows details of forward disease classification code mappings in aspecified business area.

FIG. 60 is a screen shot illustrating a report generated by the toolwhich shows details of backward disease classification code mappings ina specified business area different than that shown in FIG. 59.

FIG. 61 is a screen shot illustrating a report generated by the toolwhich shows a comparison of disease classification code modificationsmade between different disease classification code revisions.

FIG. 62 is a screen shot illustrating graphic user interface forgenerating a mapping version report showing a selected category ofdisease classification code mapping modifications made between selectedversions of disease classification code mappings.

FIG. 63 is a screen shot illustrating a mapping version report generatedby the graphic user interface illustrated in FIG. 62.

FIG. 64 is a screen shot illustrating a graphic user interface forgenerating a report showing customized disease classification codemappings made during a specified time range.

FIG. 65 is a screen shot illustrating a report generated by the toolusing the graphic user interface illustrated in FIG. 64.

FIG. 66 is a screen shot illustrating a report generated by the toolwhich shows all confirmed disease classification code mappings madeduring a specified time range for a specified business area.

FIG. 67 is a screen shot of a graphic user interface for generating areport, along with an example such report, showing an audit trail over aspecified time period for disease classification code mapping requestsmade by third parties.

FIG. 68 is a screen shot illustrating an example report showing detailsof disease classification codes included in one such audit trail reportgenerated by the graphic user interface of FIG. 67.

FIG. 69 is a screen shot illustrating a graphic user interface forgenerating a report, along with an example such report, showing a listof disease classification code mappings assigned to one or moreresponsible persons.

FIG. 70 is a screen shot illustrating a graphic user interface forgenerating a report showing disease classification code mappings thatare expired or set to expire within a specified time range.

FIG. 71 is a screen shot illustrating a report generated by the graphicuser interface of FIG. 70 showing details relating to diseaseclassification code mappings that are set to expire in the currentmonth.

FIG. 72 is a screen shot illustrating a graphic user interface forgenerating a report, along an example such report, showing an audittrail for work flow relating to mapping of a specified diseaseclassification code.

FIG. 73 is a screen shot illustrating a graphic user interface forgenerating a report, along an example such report, showing an audittrail for work flow relating to mapping of disease classification codeswithin a specified date range.

FIG. 74 is a screen shot illustrating a graphic user interface that maybe used to upload a specified claims data file by the tool for export toa payer entity.

FIG. 75 is a screen shot illustrating an example process for uploading aspecified claims data file for export to a payer entity using thegraphic user interface of FIG. 74.

FIG. 76 is a screen shot illustrating a graphic user interface that maybe used to generate a report of historical data relating to a specifiedICD-10 code in relation to a specified business area and/or a specifiedstate, and which includes identification of one or more equivalent ICD-9codes.

FIG. 77 is a screen shot illustrating an example report using thegraphic user interface of FIG. 76.

FIG. 78 is a screen shot illustrating a claims mapping distributionreport generated by the tool which shows percentages of diseaseclassification code mappings across a plurality of different diseaseclassification code categories for claims relating to one or morespecified providers, one or more specified disease classification codesand/or one or more specified states.

FIG. 79 is a screen shot illustrating a claims amount distributionreport generated by the tool which shows total charge and paymentamounts for claims relating to one or more specified providers and/orone or more specified states.

FIG. 80 is a screen shot illustrating a claims conversion distributionreport generated by the tool which shows the total number of diseaseclassification code mappings across a plurality of different diseaseclassification code categories for claims relating to one or morespecified providers and/or one or more specified states.

FIG. 81 is a screen shot illustrating a claims code distribution reportgenerated by the tool which identifies, and shows details of, diseaseclassification codes for claims of a selecting mapping category thatrelate to one or more specified providers, one or more specified diseaseclassification codes and/or one or more specified states.

FIG. 82 is a screen shot illustrating a provider comparison reportgenerated by the tool which shows a comparison, by diseaseclassification code, of claims percentages among various providers inone or more specified states and for a specified disease classificationcode mapping type.

FIG. 83 is a screen shot illustrating a provider comparison reportgenerated by the tool which shows a comparison, by claims, of claimspercentages among various providers in one or more specified states andfor a specified disease classification code mapping type.

FIG. 84 is a screen shot illustrating a provider comparison reportgenerated by the tool which shows a comparison, by claims paid andcharged amount, of claims percentages among various providers in one ormore specified states and for a specified disease classification codemapping type.

FIG. 85 is a screen shot illustrating a claims summary report generatedby the tool which shows a summary of details relating to claims of alldisease classification codes processed by the tool, in relation toclaims processed by providers, by batch code translation.

FIG. 86 is a screen shot illustrating a claims audit trail summaryreport generated by the tool which shows details of claims requests madeby payers with respect to forward or backward disease classificationcode mapping over a specified time period.

FIG. 87 is a screen shot illustrating a report generated by the toolwhich shows details about each of the number of claims of one of theclaims requests illustrated in the audit trail summary report of FIG.86.

FIG. 88 is a screen shot illustrating a report generated by the toolwhich shows details of the disease classification codes relating to oneof the claims in the report of FIG. 87.

FIG. 89 is a screen shot illustrating a graphic user interface that maybe used to upload a specified claims data file by the tool for export toa provider entity.

FIG. 90 is a screen shot illustrating an example process for uploading aspecified claims data file for export to a provider entity using thegraphic user interface of FIG. 74.

FIG. 91 is a screen shot illustrating a payer comparison reportgenerated by the tool which shows a comparison, by diseaseclassification code, of claims percentages among various payers in oneor more specified states and for a specified disease classification codemapping type.

FIG. 92 is a screen shot illustrating a payer comparison reportgenerated by the tool which shows a comparison, by claims, of claimspercentages among various payers in one or more specified states and fora specified disease classification code mapping type.

FIG. 93 is a screen shot illustrating a payer comparison reportgenerated by the tool which shows a comparison, by claims reimbursed andcharged amount, of claims percentages among various payers in one ormore specified states and for a specified disease classification codemapping type.

FIG. 94 is a screen shot illustrating a claims summary report generatedby the tool which shows a summary of details relating to claims of alldisease classification codes processed by the tool, in relation toclaims processed by payers, by batch code translation.

FIG. 95 is a screen shot illustrating a claims audit trail summaryreport generated by the tool which shows details of claims requests madeby providers with respect to forward or backward disease classificationcode mapping over a specified time period.

FIG. 96 is a screen shot illustrating a report generated by the toolwhich shows details about each of the number of claims of one of theclaims requests illustrated in the audit trail summary report of FIG.95.

FIG. 97 is a screen shot illustrating a report generated by the toolwhich shows details of the disease classification codes relating to oneof the claims in the report of FIG. 96.

FIG. 98 is a screen shot illustrating a report generated by the toolwhich shows a distribution of disease classification codes for claimsrelating to one or more specified providers, in one or more specifiedstates and/or for one or more specified disease classification codemapping types.

FIG. 99 is a screen shot illustrating a report generated by the tool inresponse to user selection of the “allocate” button in the report ofFIG. 98, which shows a list of all disease classification codescontained in the report of FIG. 98.

FIG. 100 is a screen shot illustrating a graphic user interface that maybe used to conduct a search within the tool for disease classificationcodes of a specified type by code description.

FIG. 101 is a screen shot illustrating a process for conducting a searchwithin the tool, and example results produced thereby, for diseaseclassification codes of a specified code type by code description.

FIG. 102 is a screen shot illustrating a process for conducting aforward search within the tool, and example results produced thereby,for all ICD-10 codes mapped to a specified ICD-9 code.

FIG. 103 is a screen shot illustrating a process for conducting abackward search within the tool, and example results produced thereby,for an IDC-9 code mapped to a specified ICD-10 code.

FIG. 104 is a screen shot of the main page of the tool illustratingselection of a specific application mode and business area in which tooperate the disease classification code mapping tool.

FIG. 105 is a screen shot illustrating a process for creating variousroles and levels of user access to the tool by an administrator.

FIG. 106 is a screen shot illustrating a process for editing informationof existing users of the tool by an administrator.

FIG. 107 is a screen shot illustrating a process for adding additionalapprovers by an administrator to existing workflow.

FIG. 108 is a screen shot illustrating a process for allocating mappingtasks associated with a specified type of disease classification codesto approvers by an allocator.

FIG. 109 is a screen shot illustrating a process for prioritizingmapping by approvers of one or more selected disease classificationcodes.

FIG. 110 is a screen shot illustrating a process for allocating diseaseclassification code mapping tasks by functional medical coder/approvergroup.

FIG. 111 is a screen shot illustrating a process for allocating diseaseclassification code mapping tasks in one go by functional medicalcoder/approver group.

FIG. 112 is a screen shot illustrating a graphic user interface,generated by the tool in response to user selections made to in theprocess of FIG. 111, which may be used to allocate blocks of diseaseclassification codes.

FIG. 113 is a screen shot illustrating an alternate embodiment of thedisease classification code list included in the graphic user interfaceof FIG. 112.

FIG. 114 is a screen shot illustrating an additional code list,generated by the tool for display in or in addition to the graphic userinterface of FIG. 112, showing a list of the allocated diseaseclassification codes with functional group overlap.

FIG. 115 is a screen shot illustrating an example email messageautomatically generated and sent to one or more medical coders and/orapprovers of the tool informing a task assignment.

FIG. 116 is a screen shot illustrating a process for transferring one ormore disease classification code mapping tasks by an allocator toanother medical coder or approver.

FIG. 117 is a screen shot illustrating a graphic user interfacegenerated by the tool which may be used to unconfirm one or moreselected disease classification codes prior to expiration.

FIG. 118 is a screen shot illustrating a process for generating a taskallocation status report showing a status of tasks allocated to one ormore medical coders and one or more approvers by a selected allocator inone or more specified business areas.

FIG. 119 is a screen shot illustrating a report generated by the toolshowing the status of various tasks assigned to a selected one of themedical coders included in the task allocation status report of FIG.118.

FIG. 120 is a screen shot illustrating a work list generated by the toolfor a specified medical coder which shows a list of diseaseclassification code mappings assigned to that medical coder.

FIG. 121 is a screen shot illustrating a pending list generated by thetool for the specified medical coder which shows a list of diseaseclassification code mappings processed by the medical coder and awaitingapproval.

FIG. 122 is a screen shot illustrating a rejected list generated by thetool for the specified medical coder which shows a list of diseaseclassification code mappings processed by the medical coder and rejectedby the approver.

FIG. 123 is a screen shot illustrating an escalated list generated bythe tool for a specified approver which shows a list of diseaseclassification code mappings which the approver can reassign to anothermedical coder.

FIG. 124 is a screen shot illustrating process for reassigning a diseaseclassification code mapping listed in the escalated list of FIG. 123 toanother medical coder.

FIG. 125 is a screen shot illustrating a rejected list generated by thetool for a specified approver which shows a list of diseaseclassification code mappings which have been rejected.

FIG. 126 is a screen shot illustrating transfer of a diseaseclassification code mapping, by the specified approver, from therejected list of FIG. 125 to an approved disease classification codemapping list.

FIG. 127 is a screen shot illustrating a work list generated by the toolfor a specified second level approver which shows a list of diseaseclassification code mappings assigned to that second level approver.

FIG. 128 is a screen shot illustrating a pending list generated by thetool for the specified second level approver which shows a list ofdisease classification code mappings processed by the medical coder andawaiting approval or rejection by the second level approver.

FIG. 129 is a screen shot illustrating an approved list generated by thetool for the specified second level approver which shows a list ofdisease classification code mappings that are approved for a selectedbusiness area.

FIG. 130 is a screen shot illustrating a complete list generated by thetool for the specified second level approver which shows a list ofdisease classification code mappings that are approved as well asconfirmed by all approvers for a selected business area.

FIG. 131 is a screen shot illustrating a pending list generated by thetool for a specified approver which shows an error message informing theapprover that a mapping cannot be rejected more than three times.

FIG. 132 is a screen shot illustrating a graphic user interfacegenerated by the tool which may be used to reallocate or confirm adisease classification code mapping already confirmed within the samedepartment but with a different effective date.

FIG. 133 is a screen shot illustrating a process for reallocating orconfirming a disease classification code mapping using the graphic userinterface of FIG. 132.

FIG. 134 is a screen shot illustrating a graphic user interfacegenerated by the tool which may be used to modify an end date a diseaseclassification code mapping.

FIG. 135 is a screen shot illustrating a process for modifying an enddate of a disease classification code mapping using the graphic userinterface of FIG. 134.

FIG. 136 is a screen shot illustrating a graphic user interfacegenerated by the tool which may be used to upload a document referencedduring mapping of a disease diagnostic code.

FIG. 137 is a screen shot illustrating a graphic user interface of awork list in which is displayed for download a list of referencedocuments uploaded using the graphic user interface of FIG. 136.

FIG. 138 is a screen shot illustrating a graphic user interface whichmay be used to view ICD-10 codes previously backward mapped to specifiedICD-9 codes.

FIG. 139 is a screen of the main page of the tool illustrating selectionof yet another application mode and business area in which to operatethe disease classification code mapping tool.

FIG. 140 is a screen shot illustrating a graphic user interface that maybe used to create new mappings of specified ICD-9 codes to one or morecorresponding ICD-10 codes.

FIG. 141 is a screen shot illustrating a graphic user interface that maybe used to upload claims data for export to a payer or provider.

FIG. 142 is a screen shot illustrating an example uploaded filecontaining ICD-9 codes.

FIG. 143 is a screen shot illustrating a graphic user interface foruploading the ICD-9 code file illustrated in FIG. 142.

FIG. 144 is a screen shot illustrating an example uploaded filecontaining ICD-10 codes.

FIG. 145 is a screen shot illustrating a file, generated by the tool,containing ICD-10 code ranges corresponding to the ICD-10 codescontained in the file illustrated in FIG. 144.

FIG. 146 is a screen shot illustrating a graphic user interface fordownloading the file containing ICD-10 ranges illustrated in FIG. 145.

FIG. 147 is a screen shot illustrating a graphic user interface that maybe used by an allocator to search within the tool for diseaseclassification codes for allocation based on a specified diseaseclassification code range.

FIG. 148 is a screen shot illustrating a process for generating aread-only ICD-9 to ICD-10 code mapping.

FIG. 149 is a screen shot illustrating a process for generating a listof ICD-9 and ICD-10 codes and their descriptions based on a specifieddisease classification code description and a specified diseaseclassification code type.

FIG. 150 is a screen shot illustrating an uploaded file containingfinancial neutrality average variance information for specified diseaseclassification codes.

FIG. 151 is a screen shot illustrating a graphic user interface that maybe used to upload the file illustrated in FIG. 150.

DETAILED DESCRIPTION OF THE DRAWINGS

While the concepts of the present disclosure are susceptible to variousmodifications and alternative forms, specific exemplary embodimentsthereof have been shown by way of example in the drawings and willherein be described in detail. It should be understood, however, thatthere is no intent to limit the concepts of the present disclosure tothe particular forms disclosed, but on the contrary, the intention is tocover all modifications, equivalents, and alternatives consistent withthe present disclosure and the appended claims.

This application relates to the following applications all filed on evendate herewith, the disclosures of which are incorporated herein byreference in their entirety; U.S. patent application Ser. No. ______,entitled System and Method for Ensuring Medical Benefit Claim PaymentNeutrality Between Different Disease Classification Codes and havingattorney docket No. 52809-124681, U.S. patent application Ser. No.______, entitled System and Method for Automatically Modifying SourceCode to Accommodate a Software Migration and having attorney docket No.52809-124680, U.S. patent application Ser. No. ______, entitled Systemand Method for Analyzing an Impact of a Software Code Migration andhaving attorney docket No. 52809-124679, and U.S. patent applicationSer. No. ______, entitled System and Method for Validating Medical ClaimData and having attorney docket No. 52809-124683.

References in the specification to “one embodiment”, “an embodiment”,“an example embodiment”, etc., indicate that the embodiment describedmay include a particular feature, structure, or characteristic, butevery embodiment may not necessarily include the particular feature,structure, or characteristic. Moreover, such phrases may or may notnecessarily refer to the same embodiment. Further, when a particularfeature, structure, process, process step or characteristic is describedin connection with an embodiment, it is submitted that it is within theknowledge of one skilled in the art to effect such feature, structure,process, process step or characteristic in connection with otherembodiments whether or not explicitly described. Further still, it iscontemplated that any single feature, structure, process, process stepor characteristic disclosed herein may be combined with any one or moreother disclosed feature, structure, process, process step orcharacteristic, whether or not explicitly described, and that nolimitations on the types and/or number of such combinations shouldtherefore be inferred.

Embodiments of this disclosure may be implemented in hardware, firmware,software, or any combination thereof. Embodiments of this disclosureimplemented in a computer system may include one or more bus-basedinterconnects between components and/or one or more point-to-pointinterconnects between components. Embodiments of this disclosure mayalso be implemented as instructions stored on one or moremachine-readable media, which may be read and executed by one or moreprocessors. A machine-readable medium may be embodied as any device orphysical structure for storing or transmitting information in a formreadable by a machine (e.g., a computing device). For example, amachine-readable medium may be embodied as any one or combination ofread only memory (ROM); random access memory (RAM); magnetic diskstorage media; optical storage media; flash memory devices; and others.

Referring now to FIG. 1, an embodiment is shown of a system 100 forproviding mapping between disease classification codes, i.e., betweenICD-9 code set to ICD-10 code set. Although a migration from ICD-9 toICD-10 is discussed herein for purposes of example, this disclosure isnot intended to be limited to migration from ICD-9 to ICD-10, butencompasses migration from any one medical classification system toanother medical classification system. The computing device 100 may be apersonal computer, a tablet computer, a personal digital assistant(“FDA”), a media player, a cellular telephone, or any machine capable ofexecuting a set of instructions (sequential or otherwise) that specifyactions to be taken. The system 100 according to embodiments of thepresent disclosure may include a processor 202 (e.g., a centralprocessing unit (“CPU”)), a memory 204, a video adapter 206 that drivesa video display system 208 (e.g., a liquid crystal display (“LCD”), acathode ray tube (“CRT”), a touch screen), an input device 210 (e.g., akeyboard, mouse, touch screen display, etc.) for the user to interactwith the program (e.g., browser), a disk drive unit 212, a networkinterface adapter 214, an audio in/out jack 216 that allows audio to beoutputted/received by an audio output device 218 (e.g., speaker,headphones) and microphone 220, respectively. Although a combined audioin/out jack 216 is shown for purposes of example, one skilled in the artshould appreciate that separate devices may be provided for input andoutput of audio. It will be understood that that various embodiments ofthe computing device 100 may not always include all of these peripheraldevices, and may instead include various subsets thereof. It willfurther be understood that the video display system 208 may, in someembodiments, be provided in the form of one or more conventional displaymonitors.

The disk drive unit 212 includes a computer-readable medium 216 on whichmay be stored a program code for a web browser with commonly installedplugin(s), such as Flash™ and/or Java™. In some cases, the browser mayprovide support for the emerging HTML5 WebRTC standard. Embodiments arealso contemplated in which the browser could be on a mobile internetconnected device, such as a phone or tablet, which has support for theemerging HTML5 WebRTC standard. In one embodiment, a custom applicationcould be provided on an Internet connected mobile device. The term“computer-readable medium” shall be taken to include, but not be limitedto, solid-state memories, optical media, flash memory, and magneticmedia. Embodiments are contemplated in which the browser may runapplications that are received from a server 224 over a network 102 viathe network interface device 214 utilizing any one of a number oftransfer protocols including but not limited to the hypertext transferprotocol (“HTTP”) and file transfer protocol (“FTP”). The network 102may be any type of packet-switched data network including but notlimited to fiber optic, wired, and/or wireless communication capabilityin any of a plurality of protocols, such as TCP/IP, Ethernet, WAP, IEEE802.11, or any other protocol.

Compliance with the above discussed migration from ICD-9 to ICD-10 codesets may impact the software and systems of health care providers andpayers. Embodiments of the present disclosure are directed to a diseaseclassification code mapping tool which creates mappings or mapping filesbetween ICD-9 and ICD-10 code sets in order to facilitate suchmigration.

The disease classification code mapping tool described hereinillustratively includes one or more graphic user interfaces via whichvarious disease classification code mapping personnel, e.g., medicalcoders, mapping approvers, task allocators and administrators, canaccess, configure and operate the tool. Illustratively, the tool may beoperated to translate codes, i.e., create mappings between sets ofdisease classification codes, e.g., between one or more ICD-9 codes andone or more corresponding ICD-10 codes, in real time and/or in a batchprocess mode. The tool further illustratively includes a web interfacevia which payers, providers and/or other users may obtain diseaseclassification code mappings.

The disease classification code mapping tool described hereinillustratively supports ICD-9 and ICD-10 code sets, but is not limitedto such code sets. In some embodiments, the tool performs forwardmapping, i.e., mapping of ICD-9 codes to all corresponding ICD-10 codes.In other embodiments, the tool performs backward mapping, i.e., mappingof ICD-10 codes to all corresponding ICD-9 codes. In still otherembodiments, the tool performs bi-directional mapping, i.e., forwardmapping and backward mapping. Alternatively or additionally, the toolmay perform reimbursement mapping, i.e., a single mapping of each ICD-10code to a single ICD-9 code. Any such mapping may illustratively beperformed on diagnosis codes (DC), procedure codes (PC) or both. Anysuch mappings may be exposed by the tool as a service that may beconsumed by applications belonging to different platforms, and the toolillustratively supports workflow for publishing mappings.

The tool illustratively provides general equivalence mappings (GEMs) andsupports loading newer versions of GEMs as well as mapping versioning.Additionally, the tool includes capability for customizing mappings byadding new mappings or confirming existing mappings. The tool mayfurther provide guidance in selection of mappings using customer data.The tool is illustratively integrated with a rules engine forintegrating complex business rules logic in mapping selection. The tooldelivers consistency in the interpretation of mappings between differentversions of disease classification code sets with centralized mappingand lookup availability.

The tool further illustratively provides searching capability forsearching ICD-9 and/or ICD-10 codes by code description. Advancedsearching capability may further include the ability to tag diseaseclassification codes with meta-tags, thereby providing for intelligentsearching of codes.

The tool further illustratively includes data analytics capability forcreating reports relating to disease classification codecategorizations, provider and/or payer comparisons, and the like. Trendanalysis may further be performed on historical data, e.g., to narrowdown one-to-many mappings.

Referring now to FIG. 2, a simplified block diagram is shown of asoftware environment of the system of FIG. 1. In the illustratedembodiment, the disease classification code mapping tool is implementedin the form of instructions stored in the memory 204 of the system 100and executable by the processor 202 to perform the functions describedherein. Alternatively or additionally, the instructions may be stored inwhole or in part on the computer-readable medium 216, and/or on theserver 224 and accessed by the processor 202 via the network 102.Alternatively or additionally still, the server 224 may include one ormore processors which execute the instructions, and input/output datamay be exchanged between the processor 202 and the server 224 via thenetwork 102. In any case, the disease classification code mapping toolincludes a user interface module 230, a data management module 240, aconfiguration module 250, an ICD code mapping module 260, a dataanalytics module 270, a business rules logic module 280, a reportsmodule 290, a workflow management module 294 and a search engine 298.

The user interface module 230 illustratively includes a number ofgraphic user interfaces via which users of the tool may inputinformation into the tool, access information from the tool, configurethe tool for operation, operate the tool to create diseaseclassification code mappings, manage workflow, create reports, and thelike. In this regard, the user interface module 230 illustrativelyincludes a plurality of graphic user interfaces 232 for inputting data,selecting configuration options and code searching, i.e., searching fordisease classification codes. The user interface module furtherillustratively includes a plurality of graphic user interfaces 234 forviewing analytical reports and other information produced by andotherwise available via the tool. The user interface module 230 furtherillustratively includes a plurality of graphic user interfaces 236 formanaging workflow of and to the tool.

The data management module 240 is operable to manage information inputto the tool and information selection during operation of the tool. Thedata management module 240 is further operable to manage ICD codetransfer within the tool, and to manage data downloads and uploads.

The configuration module 250 is operable to import and export ICD codemappings, to modify ICD code mappings, e.g., by adding ICD codes notpresent in ICD code sets, and to modify ICD codes, e.g., by adding codetags. The ICD code mapping module 260 is operable to createbidirectional mappings and reimbursement mappings between ICD-9 andICD-10 code sets on both diagnosis codes and procedure codes, tocustomize ICD code set mappings and to create new ICD code mappings,e.g., for different business areas. The data analytics module 260 isoperable to process and analyze claims data and produce analyticalreports for payers and providers. The business rules logic 280 containsbusiness rules for creating ICD code mappings and for generating variousreports. The reports module 290 is operable to generate various mappingreports and produce reports generated by the data analytics module 260.The workflow management module 294 is operable to allow administrators,allocators, approvers and medical coders to create and manage work flowrelating to the creation and confirmation of ICD code mappings. Thesearch engine 298 is operable to search ICD codes by code description,and to conduct advanced searching using code tags.

Referring now to FIG. 3, a block diagram is shown depicting an examplearchitecture 300 of the disease classification code mapping tool. Thearchitecture includes, but is not limited to a presentation layer 302, aservice interface layer 304, a business layer 306, and a data accesslayer 308. The presentation layer 302 illustratively provides a graphicuser interface (“GUI”) for users 320 (e.g., medical coders, claimsspecialists, administrators, and the like) to upload data. Thepresentation layer 302 may be built, for example, with Microsoft WindowsForms using the .NET framework. The service interface layer 304 enablesmessage transfer from the presentation layer 302 to the business layer306 and vice versa, accepting inputs, and returning appropriate codes tothe users. Supporting a Service Oriented Architecture (“SOA”), it alsointerfaces with other applications 330 external to the translationsystem such as, but not limited to, legacy systems and open systems.

The business layer 306 contains components which implement the businesslogic and rules (e.g., via a rules engine 340) responsible for thefunctionality of the tool. These components include, but are not limitedto: an uploads processor, forward/backward mapping processor,customization/history processor, analytics processor, and areimbursement processor.

The system supports SQL-based relational database systems through itsdata access layer 308, such as Oracle and Microsoft-SQL Server. Such asystem database 310 acts as a central repository for all GEMs mappings,reimbursement mappings, mappings history, and customized mappings data.The system database 310 is coupled to a pre-defined mainframe interface360 which provides for communication between the database 310 and theexternal applications 330.

The presentation layer 302 also handles any data access and businesslogic exceptions, and illustratively includes all graphic user interfacerelated functionalities for web service deployment of the tool on, e.g.,an internet information services (IIS) web application server 390.

An exception handling layer 370 handles all exceptions, and events areeventually logged into a file to provide a complete trace of anexecution process. In some embodiments, a security layer 390 employsWindows authentication using Active Directory and role-based security.

The above described architecture is designed to support seamlessvertical scaling. In the case of high transaction volume and/orrequirements for catering to a large user base, the web/applicationservers can be clustered to deliver the load evenly across servers.Clustering of an IIS server with a load balance can serve to balance theload by distributing multiple instances of the application acrossseparate processing machines. A suitable load-balancing algorithm, suchas a round-robin algorithm may be employed for load balancing. Also,Microsoft Network Load Balancing (“NLB”) can be leveraged for loadbalancing capabilities. Efficient fail-over and fail back of thetransactions and sessions during operation of an application can also beimplemented. A fail-over mechanism for web/application servers can beimplemented using a hot-stand-by node, which may help to alleviatecrashes and service downtime. Accordingly, deployment in a cluster mayensure that there is no single point of failure for any application.

According to embodiments of the present disclosure, the term “user”herein may refer to any of the following entities, but not limited tothe following entities: healthcare organization, allocator, approver,medical coder, administrator, super administrator. In light ofembodiments of the disclosure discussed herein, one of ordinary skill inthe art may understand the relationships between each of the abovelisted entities, which are used throughout. Further, according toembodiments of the present disclosure, systems and methods may restrictaccess to certain functionalities and processes to only certain types ofusers. For example, an administrator may be able to restrict the use ofcertain ICD codes by medical coders. As another example, an allocatormay be able to allocate certain tasks or responsibilities associatedwith selected ICD codes to certain other types of users (e.g., medicalcoders). By way of non-limiting example only, a certain type of user(e.g., an administrator) may need to confirm a particular mapping beforeits actual implementation. Details of these user dynamics will bediscussed in more detail below in conjunction with other embodiments ofthe present disclosure discussed below.

After a user enters a valid username and password at a login screen, theuser is illustratively presented with a main page, an example of whichis illustrated in the screen shot 4 of FIG. 4. The main pageillustratively provides a number of options for operating the toolincluding, but not limited to: Home 402, Administration 404, Configure406, Mapping 408, Reports 410, Payer Data Analyzer 412, Provider DataAnalyzer 414, and Search 416. The user will generally first select anappropriate Application Mode and Business Area, e.g., using drop downlists 420 and 430, respectively. In some embodiments, the translatortool may operate in two different application modes 420: GEMs andSpecific. In GEMs mode, all mapping and other results are generatedbased on GEMs files. As discussed above, GEMs are mapping tools that actmainly as a crosswalk between ICD-9 and ICD-10, such that one can lookup an ICD-9 code and be provided with the most appropriate ICD-10matches and vice versa. GEMs files are provided by the Centers forMedicare and Medicaid Services (“CMS”) and the Centers for DiseaseControl and Prevention. In Specific mode, on the other hand, all mappingand other results are generated based on code sets provided by anallocator. As used herein, an allocator refers to an entity associatedwith the user, such as an employee, or other authorized representativeof a healthcare organization. The Business Area menu 430 provides a listof business areas, within which a user can view a mapping. Examplebusiness areas 430 may include, but are not limited to, Enrollments,Claims, ICD-10, Commercial, Care Administration, Clinical enrollments,Eligibility Management and Pre-authorization/Referral. As shown in thescreen shot 5 of FIG. 5, the user has selected GEMs as the applicationmode 420 and Enrollments as the business area 430.

The following description of the disease classification code mappingtool will be presented, in order, according to the following topicareas:

I. Configuration

II. Mapping

III. Reports

IV. Data Analytics

-   -   A. Payer Analytics    -   B. Provider Analytics

V. Searching

VI. Workflow Management

VII. New Mappings

VIII. Code List Conversion and Financial Neutrality

I. Configuration

FIG. 6 shows an example screen shot 6 of a configuration home page. Theconfiguration home page allows a user to upload ICD-9 codes, ICD-10codes, as well as different versions of GEMs mapping files includingthose of years 2012, 2013, 2014, etc. Specifically, the user can uploadversions of ICD code through code box 602 and mappings through mappingbox 604. The translation system includes a configuration feature whichmay include the following functionality:

-   -   Upload GEMs Mapping    -   Upload Specific Mapping    -   Upload Specific Mapping from GEMs Data    -   Customize Mapping    -   Add Code Tag    -   Export Mappings    -   Pre Allocation for Code (as per coder skill sets)    -   ICD-10 Code Ranges    -   Convert ICD-9 Code List/Ranges    -   Upload GEMs Mapping—A user can upload full GEMs mappings,        partial GEMs mappings, or simply view mappings of selected        codes.

If a user chooses to upload a particular year's version of GEMs mapping(i.e., the 2013 GEMs mapping version), the user can select the desiredversion in drop down box 608. Upon clicking a browse button 610, theuser may select a path from the dialog box from which to retrieve andupload the file or otherwise enter the file path in the file selectionwindow 606. Use of upload button 612 may be disabled once a particularversion GEMs file is uploaded. After a successful upload, an uploademail is generated and sent to all registered users of the translationsystem.

The configuration feature also allows a user to perform a partialupload, or partial mappings (mappings of a portion of all codes) of afile. Specifically, the user can enter, or search for, a path of thefile in the file selection window 606, click on the browse button 610,and click on the Partial Upload button 614. If the file size is toolarge to upload, then the file can be split into smaller parts and thenuploaded using the partial upload feature. Also, this feature may beused for appending additional information. For example, ICD-9 code“707.20” does not have any equivalent ICD-10 code according to the GEMsmapping. In such situations, a user can define mappings for these codesas per their own organization's practice, and upload them using thepartial upload functionality.

A user may view a selected code and associated description by clicking aview button 616. By selecting ICD-9 or ICD-10 codes and then clickingthe view button 616, the user can view all codes with their description.

FIG. 7 is a screen shot 7 illustrating a process for uploading aspecific mapping, which has the same upload and view functionality asthe upload GEMs mapping feature discussed above, e.g., a code box 702, amapping box 704, file selection window 706, browse button 708, uploadbutton 710 and view button 712.

FIG. 8 is a screen shot 8 illustrating a process 802 for uploading codeset files based on functional groupings for use by an externalapplication such as, for example, the tool illustrated and described inco-pending U.S. patent application Ser. No. ______, entitled System andMethod for Ensuring Medical Benefit Claim Payment Neutrality BetweenDifferent Disease Classification Codes and having attorney docket No.52809-124681. The user selects a mapping file using the file selectionwindow 804 and/or browse button 806, or selects the file by entering afile description in a dialog box 808, and then selects the submit button810. The uploaded file will illustratively be an Excel™ file or other.xls file.

FIG. 9 is a screen shot 9 illustrating a process 902 for uploading aspecific mapping from the GEMs data in the form of a text file or Excel™spreadsheet with a code list (or range). The user may specify an Excel™or text file that contains the subject ICD-9 code list and code ranges.A screen shot 10 showing an example Excel™ file of a code list and rangeis shown in FIG. 10. The user selects a code set type, e.g., ICD-9diagnosis codes 904 or ICD-9 procedure codes 906, then selects a GEMsfile using the file selection window 908 and/or browse button 910, orselects the file by entering a file description in a dialog box 912, andthen selects the upload button 914. The tool will then convert the codelist and ranges into an appropriate format. The system can identifyevery ICD-9 code within the selected code range as from the ICD-9 codeslisted in the GEMs mappings and populate those codes in the specificmode master tables. Likewise, the mapped ICD-10 codes within that range,along with their descriptions, will also be populated. For BackwardMapping, the user would need to specify an Excel™ or text file whichcontains the ICD-10 code list and code ranges, and the a mapped list ofICD-9 codes will populated in a similar fashion.

FIG. 11 is a screen shot 11 illustrating a process 1102 for extractingand appending ICD-9 codes not present in a customer uploaded input file.The user selects a code set type, e.g., ICD-9 diagnosis codes 1104 orICD-9 procedure codes 1106, then selects an input file using the fileselection window 1108 and/or browse button 1110, and then selects theupload button 1112. The tool will accept customer-provided ICD codes andcode lists from the front end, and it will identify extra ICD-9 codesreferencing the GEMs mapping codes. The extra codes may be tagged to adefined functional group within the tool. The tool also has the abilityto extract the ICD-9 codes. In any case, the user may select the exportbutton 1114 to export the file.

FIG. 12 is a screen shot 12 illustrating a process 1202 for customizingan existing ICD code mapping. To customize a forward mapping 1204 (ICD-9to ICD-10), a user enters an ICD-9 code to be mapped in box 1208, and/oruses a code lookup button 1210 to identify a desired ICD-9 code. The getequivalent ICD-10 code button 1212 is then selected, and a list of allcandidate mapped ICD-10 codes is provided as illustrated by the userinterface 1302 shown in the screen shot 13 of FIG. 13. Illustratively,the user interface is configured, e.g., by color coding or otherdistinguishing feature(s), to identify and distinguish the candidateICD-10 codes as between GEMs mapping 1308 and customized mapping 1310.The provided ICD-10 code(s) can be saved as a mapped code(s) byselecting the save button 1302.

Editing of a candidate code may be accomplished by selecting the editlink 1306 adjacent to the ICD-10 code line. An example of such anediting process is illustrated in the screen shot 14 of FIG. 14 whichillustrates a backward mapping of a selected ICD-10 code to one or moreequivalent ICD-9 codes using the user interface 1202 illustrated in FIG.12. As shown in the user interface 1410, the selected ICD-10 code isidentified by the tool as having three sets of corresponding ICD-9codes. In the example illustrated in FIG. 14, the first line ofequivalent ICD-9 codes is selected for edit, by selecting the edit linkadjacent to the first line of equivalent ICD-9 codes in the userinterface 1410, which action produces the user interface 1402 above theuser interface 1410. The user interface 1402 shows each of theequivalent ICD-9 codes in a separate window, e.g., 1404, and the one ormore equivalent ICD-9 codes in the user interface 1402 may be updated,i.e., by adding one or more additional ICD-9 codes, by changing one ormore of the ICD-9 codes and/or removing one or more of the ICD-9 codesshown. Selection of the update button 1406 produces the updated list inthe user interface 1410, and changes can be saved using the save button1312. New rows of ICD codes can also be added in either forward orbackward mapping by selecting the add new row button 1504 as shown inthe user interface 1502 of the screen shot 15 shown in FIG. 15. As shownin the screen shot 16 of FIG. 16, customized ICD codes can be reset totheir original GEMs mapping in some embodiments by selecting a resetbutton 1604 which may be provided in user interface 1602 of mapped codecandidates.

FIGS. 17 and 18 are screen shots 17 and 18 respectively illustrating aprocess 1702 for adding a code tag to one or more ICD codes. Thisfeature allows a user to add a tag to selected ICD codes to facilitate asearch for ICD-codes. Therefore, at any later point in time, the usercan search for a code by the associated tag. The user can search for adesired ICD code by entering the code, or a portion thereof, in searchfield of the user interface 1702. By selecting get description in theuser interface 1702, the user is presented with another user interface1802 showing a list of codes matching the search terms. The user can adda tag to any of the listed codes by clicking an edit link adjacent tothe code in the interface 1802. As shown in FIGS. 17 and 18, the user isusing the feature to add a search tag for ICD codes starting with “017”.

FIGS. 19-22 are screen shots 19-22 respectively illustrating a process1902 for exporting mappings. The tool can illustratively export mappingsin flat file format, although it is contemplated that the tool mayalternatively or additionally export the mappings in any suitableformat. For export, the user has the ability to download any originalmapping or customized mapping. As shown in FIG. 19, the user interface1902 includes all mapping 1904 and functional group wise mapping 1906buttons for exporting correspondingly selected mappings. By selectingall mapping 1904, all original mappings (GEMs or Specific, dependingupon operating mode) can be exported. The mapping is selected in adialog box 1908, and a download button 1910 is selected to download thespecified mapping file (e.g., a forward or backward mapping file). Asshown in FIG. 20, by selecting functional group wise mapping 1906, thetool modifies the user interface 1902 to include a functional groupselection dialog box 2002 which may be used to select a desiredfunctional group or business area of mappings, i.e., a collection of ICDcode mappings previously tagged with an identification tag identifyingthose ICD codes in the collection with the corresponding business area.When the functional group is selected, the download button 1910 is thenselected to download the specified mapping file. As shown in FIG. 21, afile download dialog box 2102 will open in either case (all mapping orfunctional group wise mapping) after clicking the download button 1910.The user can save the mapping to any location in flat file format (.txt)or any other format, for that matter. The downloaded file name may be inthe mapping type .txt format. For example, “forward_mapping(ICD-9-CM_to_ICD-10_CM_Mapping).txt as shown in FIG. 21. A screen shot22 illustrating an example of a downloaded file 2202 is shown in FIG.22.

FIGS. 23-25 are screen shots 23-25 respectively illustrating a processfor tagging ICD codes with different skill sets, e.g., as betweendifferent parts of the body. In one embodiment, the illustrated processis restricted for use by authorized administrators or allocators, whichcan enter an ICD code in the text box of a user interface identical (orsimilar) to the user interface 1702 illustrated in FIG. 17 to retrieveits description as shown in the user interface 2302 in FIG. 23. Byclicking on the edit link in the user interface 2302, the tool producesa menu 2402 above the interface 2302 of all available skill sets (e.g.,body parts) associated with the selected ICD code, as shown in FIG. 24.The tool adds a tag to the selected ICD code for each skill set selectedfrom the menu 2402 of skill sets.

In addition to adding skill sets to ICD codes, the tool provides forupdating skill sets available for certain medical coders and approvers.As shown in FIG. 25, a selectable list 2502 is shown of business codes,i.e., users of the system, e.g., allocator, approver, medical coder andbusiness user, of business areas, e.g., enrollments, careadministration, claims, commercial, eligibility management andpre-authorization/referral, and of skill sets, e.g., hand, heart, leg,eye, ear nose, lungs, fever and skin. Certain medical coders and/orapprovers may be proficient (or certified) to code diagnosis andprocedures related to certain body parts (i.e., skill sets) and notothers. Therefore, medical coders and their approvers may only beallowed to code certain diagnosis and procedures. This functionalityprovides authorized users with the ability to modify the codes ofassociated skill sets that a medical coder and approver are allowed touse.

FIG. 26 is a screen shot 26 illustrating a process for allowingauthorized users to create tasks for a specific medical coder, approver,and the like. Specifically, from the user interface 2602 shown in FIG.26, an authorized user (e.g., allocator) may select a medical coder 2604and approver 2606, and a list of codes 2612 will be displayed. Byselecting “all codes” 2608, the list of codes 1612 will include allcodes assigned to the selected combination of medical coder andapprover. Alternatively, the search button 2610 may be used to searchfor and select such codes. The illustrated process may be selectivelycarried out with respect to forward and backward mapping via appropriateselection in the user interface 2602. In any case, by checking acorresponding box, e.g., 2616, the adjacent code can be added (orremoved by unchecking) from the capability of the above selected medicalcoder. Comments relating to the task allocations can be made andattached to the allocation using the comment field 2614.

FIGS. 27-28 are screen shots 27-28 respectively illustrating a processfor allowing a user to work with ICD codes within selected ranges. Withthe user interface 2702, the user can specify input an excel file via adialog box 2708 which contains a list of ICD-10 codes (e.g., diagnosis2704 or procedure 2706 codes). By selecting the get ICD-10 code rangesbutton 2710, the tool will retrieve GEMs mapping data from its databasein a sorted order, and compare this sorted list to the range of codes inthe list input by the user. The tool will output, in the form of anExcel™ spreadsheet, a list of ICD-10 codes from the GEMs data thatcorrespond to the range of ICD-10 codes input by the user, as shown bythe pop-up box 2802 illustrated in FIG. 28. The user may view and/orsave this file as appropriate.

FIGS. 29-30 are screen shots 29-30 respectively illustrating anotherprocess for uploading ICD code ranges for which the input is a range ofICD-9 codes instead of ICD-10 codes. For example, the user can uploadvia a user interface 2902, e.g., with file description 2904, an excelfile containing a list of ICD-9 codes (diagnosis or procedure), and thetool will retrieve GEMs data from its database in a sorted order andcompare this sorted list to the range of codes in the list uploaded bythe user. In addition to an output list of ICD-9 codes in accordancewith the GEMs data, the tool may output a list of mapped ICD-10 codes(from the GEMs data) that correspond to the range of ICD-9 codes, whichfile may be downloaded using the link 3002 as shown in FIG. 30.

II. Mapping

Upon clicking on the mapping tab 408 (FIGS. 4-5), functionalities arepresented to the user including GEMs mapping (e.g., diagnosis andprocedure mapping) and section mapping. If the user selects GEMsmapping, the user is presented with four functionality options: ForwardMapping, Backward Mapping, Reimbursement Mapping, and HighlightingSimilar Mapping/Color Coding.

FIG. 31 is a screen shot 31 illustrating a process for forward GEMsmapping of selected ICD-9 codes. A user interface 3102 includes a set ofradio buttons 3104, 3106 and 3108 for selecting forward, backward andreimbursement mapping respectively, and in the screen shot 31 of FIG. 31the forward mapping radio button 3104 is selected. In response toselection of the forward mapping button 3104, the tool causes the userinterface to display a dialog box 3110 for entering a selected ICD-9code to forward map to one or more ICD-10 codes. A code lookup button3116 is included to assist locating ICD-9 codes. When the ICD-9 code isselected, a graphic 3120 is displayed by the tool which shows theselected ICD-9 code and its description. Upon user selection of the getequivalent ICD-10 code button 3112, the tool searches the database andpresents via a user interface 3130 listing corresponding ICD-10 codes.As shown in the example screen shot illustrated in FIG. 31, the userinterface 3130 includes an option column 3132 by which a user can selecta specific ICD-10 code, having a description shown in a descriptioncolumn 3134, to which to map the entered ICD-9 code by checking a boxadjacent to the particular ICD-10 code in the option column 3132. Astatus column 3136 of the user interface 3130 displays a mapping statusof the corresponding ICD-10 code in relation to the selected ICD-9 code.As shown in FIG. 32, when the user has selected the check box in theoptions column 3132 for the firsts ICD-10 code listed, and has thenselected the save button, and the tool displays a message 3202indicating that the selected mapping has been saved.

Illustratively, the forward mapping feature illustrated in FIGS. 31-32provides three particular utilities: Code Look-up, View Mapping History,and Confirm Mapping. FIG. 33 is a screen shot 33 illustrating the codelook-up process which allows a user to view ICD-9 codes by entering anICD-9 code into an ICD-9 code field 3302 and then selecting a searchbutton 3306. As shown in FIG. 33, the tool conducts the search andproduces a graphic 3310 which shows the code and its correspondingdescription, as well as any tag(s) associated therewith. As shown in thescreen shot 34 of FIG. 34, users may alternatively or additionally viewICD-9 codes by entering a keyword description of an ICD-9 code, whichproduces a list 3402 of all ICD-9 codes that match the entereddescription. Using the look up by code methodology, a user can alsoenter an approximate, or a portion of an ICD code (e.g., “416”), or aportion of a code description. Upon clicking the search button 3306, allICD-9 codes starting with 416 will be displayed. Alternatively still,the user may select one or more number and/or letter links 3308 tosearch for codes starting with the selected number(s) and/or havingdescriptions starting with the selected letter(s). Illustratively, allICD-9 code records may be produced in the list 3402 by entering “%” inthe code box 3302. In any case, a user can select any displayed ICD-9code for mapping services.

FIG. 35 is a screen shot 35 illustrating a user interface 3502 producedby the tool which allows a user to view details of any previously mademappings. Specifically, as shown in the illustrated example, a user canview who made previous mappings and when the mappings were originallymade, and when they were confirmed or unconfirmed. Other history detailsinclude the approver name, reason by approver, effective date, and enddate.

FIG. 36 is a screen shot 36 illustrating a process for confirmingforward mappings. As discussed above, multiple mappings may be availablefor a particular ICD code. For these codes, a user may need to confirmone or more, of the multiple mappings available. Any code can beconfirmed by simply checking or unchecking the option button in theoption column of the code list 3130, e.g., box 3602 as shown in FIG. 36,and clicking on save (see FIG. 31). To unconfirm any code mapping, auser can simply uncheck the option button and then select save.Successful changes are notified via a suitable on-screen message 3604.

A user can also specify a certain period for which a code mappingconfirmation is valid. Specifically, an authorized user (e.g.,administrator) can go to the mapping section and click on GEMs mappingand then to diagnosis. The authorized user may then enter an ICD-9 codeinside a textbox and get an equivalent ICD-10 code, as was previouslydiscussed. After checking the box and saving, as shown in the examplescreenshot 37 in FIG. 37, a pop-up window 3702 will open, prompting theauthorized user to enter an effective date 3706 and end date 3704 forthe confirmation, and a reason in a text box 3708 for setting the timerestrictions. These dates define the period of time for which a userwould like to confirm a selected code mapping. A corresponding referencedocument can be uploaded by selecting the button 3710.

After confirming a mapping, an email is automatically generated and sentby the tool to the administrator as well as all medical coders/approversdescribing the newly confirmed mapping. This email is sent in situationswhen the administrator or allocator is confirming any mapping. If theuser is an approver, and the approver approves any code, mail is sentfrom the administrator to the medical coder for the given confirmation.Similarly, an email is sent when a mapping is rejected, a copy of whichis sent to the administrator and his allocator. FIG. 38 is an examplescreen shot 38 of such an email 3802 illustrating the above discussedconfirmation and including a chart 3804 including relevant ICD codeinformation.

FIG. 39 is a screen shot 39 illustrating a GEMs backward Mappingprocess. As shown in the illustrated example, backward mapping providesequivalent ICD-9 codes for a specified ICD-10 code. For example, thebackward mapping button 3106 is selected in the user interface 3102, thetool modifies the interface 3102 to include an ICD-10 dialog box forentering a selected ICD-10 code. When an ICD-10 code is entered, thetool produces a graphic 3902 of the selected ICD-10 code and itsdescription, and upon clicking the “Get Equivalent ICD-9-CM Code” box inthe user interface 3102, the tool displays a list 3904 of correspondingICD-9 codes. Similar to the forward mapping feature, the backwardmapping feature allows a user to perform code look up and mappingconfirmation functionality, and the list 3904 likewise illustrativelyincludes an option column 3906, an ICD-10 code description column 3908and an ICD-10 code status column 3910.

As shown in the example screenshot 40 of FIG. 40, the translation toolcan also perform reimbursement mappings by selecting the reimbursementmapping button 3108 in the user interface 3102. As used herein,reimbursement mappings are mappings that were created to provide atemporary but reliable mechanism for mapping records containing ICD-10diagnosis and procedure codes to “reimbursement equivalent” ICD-9diagnosis and procedure codes, so that while systems are being convertedto process ICD-10 claims directly, the claims may be processed by thelegacy systems.

Unlike GEMs mappings, which include all plausible translationalternatives for each code in a system, the reimbursement mappings offera single recommended mapping of each ICD-10 code to a single ICD-9 codealternative. Specifically, each ICD-10 diagnosis code is mapped to asingle ICD-9 diagnosis code and each ICD-10 procedure code is mapped toa single ICD-9 procedure code. For example, if a user enters a desiredICD-10 code in the ICD-10 code field and then selects the “Getequivalent Reimbursement CM code” button, the tool produces a graphic4002 identifying the selected ICD-10 code and its text description, anda user interface 4004 containing a single mapped ICC-9 reimbursementcode.

FIG. 41 is a screen shot 41 illustrating a code map highlightingfeature. As shown in FIG. 41, the backward code mapping of FIG. 39 isshown in which the two rows of ICD-9 codes in the user interface 3904are specifically configured to identify a mapping category. In oneembodiment, different colors (or, alternatively four differentcross-hatchings or other line-based shading) are used to identifydifferent mapping categories, and in the illustrated embodiment fourdifferent colors are used to identify four different correspondingmapping categories. For example, blue (or other color shading) may beused to identify codes showing reimbursement mapping, orange (or othercolor shading) may be used to identify codes showing similarreimbursement mapping and backward mapping, yellow (or other colorshading) may be used to identify codes showing similar mapping inforward and backward mapping, and gray (or other color shading) may beused to identify codes showing different mapping in forward and backwardmapping. In FIG. 41, for example, the first row in the user interface3904 is yellow, identifying the corresponding ICD-9 code as showingsimilar mapping in forward and backward mapping, and the second row isorange, identifying the corresponding ICD-9 code as showing similarreimbursement mapping and backward mapping. Illustratively, the tool mayinclude a suitable chart 4106 with the user interface 3904 which definesthe illustrated highlighting.

FIGS. 42 and 43 are screen shots 42 and 43 respectively illustrating aprocess for allowing an administrator to check any confirmed codemappings in a selected business area. Specifically, an administrator canlog in, select a business area and check in a selected business area orall lines of business (“LOB”), what particular codes have already beenconfirmed. As shown in FIG. 42, for example, an administrator hasaccessed the forward mapping illustrating in FIG. 31, and in thismapping the tool includes an “all LOBs” link 4202 which, if selected,produces the report 4302 illustrated in FIG. 43 listing all businessareas with which the ICD-9 code listed in the user interface 3130 isalready confirmed.

Accessible by the administrator and the allocator type users, anotherfeature of the system allows administrators and allocators the abilityto confirm a group of one-to-one type mappings at one time, otherwiseknown as a “bulk confirm”. As shown in the example screen shot 44 inFIG. 44, the user is able to view a detailed list of potential mappingsbetween selected ICD-9 and ICD-10 codes. A user interface 4402 isillustratively produced by the tool which includes a forward mappingbutton 4404, a backward mapping button 4406, a priority menu 4408, asearch type menu 4410, a description dialog box 4412, a “get all codes”selection box 4414 and a search button 4416. By checking multiplecheckboxes at one time, the multiple code mappings shown in thecorresponding table 4420 produced by the tool will be confirmed by oneclick of the confirm button 4422. Once the user selects the confirmbutton 4422, a pop up window 3702 may open, as illustrated in the screenshot 45 of FIG. 45, prompting the user to enter a reason for theconfirmation, as well as start and end dates for when the confirmationis effective.

The disease classification code mapping tool further allows a user towork on code mappings with respect to a particular section or categoryof code. FIG. 46 is a screen shot 46 illustrating a process by which auser can enter a category for a code (e.g., all ICD-9 codes beginningwith 290), and the system will retrieve and display any possible mappedICD-10 code categories as well as the percent distribution of codes fromthese codes. A user interface 4602 associated with this process includesa category button 4604, a section button 4606, an ICD-9 code input box4608 and a search button 4610.

The functionality works in a similar fashion for backward mappingdescribed above, except the input is an ICD-9 category 4604 or ICD-9section 4606, and a corresponding ICD-9 code, and the output includes aforward mapping list 4620 and a reverse mapping list 4630. In theillustrated example, the ICD-9 category button 4604 is selected, and theforward mapping list 4620 shows all ICD-10 code category ranges in thecategory in which the selected ICD-9 category range is forward mapped,along with the percentage of mapping, and the backward mapping list 4630shows all ICD-9 code category ranges backward mapped to the ICD-10 codecategories listed in the forward mapping list 4620, along with thepercentage of mapping. The screen shot 47 of FIG. 47 shows an exampledetailed list 4702 of the ICD-9 and corresponding ICD-10 codes in theforward mapping list of the ICD-9 code category range selected in theexample shown in FIG. 46. The list 4702 is illustratively produced bythe tool upon selection of the ICD-9 code category range within theforward mapping list 4620.

The screen shot 48 of FIG. 48 shows an example of section mapping usingthe process illustrated in FIG. 46. In the illustrated example, the userhas selected the section button 4606 in the user interface 4602 and hasentered a range of ICD-9 diagnosis codes. The forward mapping list 4802includes a list of all ICD-10 code sections forward mapped to theidentified ICD-9 code range, along with corresponding mappingpercentages, and the backward mapping list 4804 includes a list of allICD-9 code sections backward mapped to the ICD-10 code sections listedin the forward mapping list 4802, along with mapping percentages.

III. Reports

Embodiments of the present disclosure allow a user to view variousreports related to any mappings. In some embodiments, the reportssection gives the user the following options:

Mapping History Report

Mapping Distribution Report

Mapping Comparison Report

Mapping Across Business Area Report

Mapping Across Version Report

Business Area Wise Mapping Report

Versioning Report

Customized Mapping Report

Published Mapping

Audit Trail Report

Expiry Mapping Details Report

Work Flow Audit Trail Report

1. Mapping History Report—FIG. 49 is an example screen shot 49 of theimplementation of a mapping history report 4920 produced by the toolwhich tracks changes in disease classification code mappings across aselected date range. By entering “from” 4908 and “to” 4910 dates andselecting “search” 4912 in a user interface 4902, the tool produces amapping history report 4920 as shown by example in FIG. 49. The report4902 may be generated on the basis of either diagnosis or procedurecode, and may be generated based on forward mapping 4904 or backwardmapping 4906. In the example shown in FIG. 49, a mapping history report4902 of forward mapping has been selected. Further details about anycode listed in the report 4902 can be viewed upon clicking a code linkon the code in the report 4902. FIG. 50 is an example screen shot 50 ofa detailed mapping history 5002 about a selected code from the report4902.

2. Mapping Distribution Report—FIG. 51 is an example screen shot 51 ofthe implementation of a mapping history report 5102 produced by the toolwhich shows percentages of disease classification codes across aplurality of different disease classification code categories for aspecified business area and a specified disease classification codetype. As shown in the example report 5102 illustrated in FIG. 51, themapping distribution report 5102 shows a percentage of each type of codemapping for any selected business area by diagnosis or procedure. Thesetypes of mappings may include: one-to-one unconfirmed, one-to-manyunconfirmed, confirmed, customized, and no mapping. By clicking on acorresponding code mapping link, a user can view a more drilled downmapping distribution report particular to that code mapping type. Forexample, referring to an example screen shot 52 in FIG. 52, a mappingdistribution report 5202 is shown specifically for confirmed diagnosiscode mappings showing the percentage of types of confirmed codemappings.

FIG. 53 is an example screen shot 53 of a list 5302 of ICD-9 codes andtheir respectively mapped ICD-10 codes with respect to a selectedbusiness area. To export any of the lists of all codes in one codemapping type, a user can choose to export the codes to Excel™, whichwill show a list of the associated codes, as shown in the report 5402illustrated in the example screen shot 54 of FIG. 54.

3. Mapping Comparison Report—A mapping comparison report shows resultsof a reimbursement mapping when a confirmed mapping is different frombackward mapping. As illustrated in the example screen shot 55 of FIG.55, a mapping comparison report 5520 can be provided on a code basis anddescription basis, e.g., by specifying an ICD-10 code in a dialog box5504 of a user interface 5502, and/or by using a code lookup feature5506, and selecting a search button 5508. By checking the box 5510, alist of comparison records is generated.

4. Mappings Across Business Area Report—Referring now to FIGS. 56 and57, a mappings across business area report may be generated by selectingvia a user interface 5602 between forward mapping 5604 and backwardmapping 5606, and, when selecting forward mapping as shown in FIG. 56,by entering an ICD-9 code (with or without code lookup 5610), and byselecting a “get equivalent ICD-10 code” button 5612. When selectingbackward mapping as shown in FIG. 57, an ICD-10 code (with or withoutcode lookup) is entered, and a “get equivalent ICD-9 code” button isselected. FIG. 57 shows an example of a resulting ICD-10 graphic 5720identifying the selected ICD-10 code and its corresponding description,and a resulting report 5730 showing ICD-9 codes mapped thereto acrossvarious business areas.

5. Mapping Across Versions Report—A mapping across versions reportallows a user to view changes in code mappings across different mappingversions. As shown in the example screen shot 58 in FIG. 58, forexample, a user interface 5802 illustratively includes a forward mappingbutton 5804, a backward mapping button 5806 and a reimbursement button58-8, as well as an ICD code dialog window 5810 and corresponding codelookup feature 5812, and a code equivalent retrieval button 5814.Depending upon the report parameters specified by the user, the toolproduces a corresponding report of previous versions of code mappings tothe ICD code specified in the user interface 5802. In the exampleillustrated in FIG. 58, the user has entered forward mapping of ICD-9code “002.9” in the user interface 5802, and the tool responds bydisplaying a listing of the corresponding mapped ICD-10 code for each ofthree different versions 5820, 5830, 5840 respectively. As shown in FIG.58, the same mapped ICD-10 code “A01.4” is provided for each availablemapping version set 2012, 2013, and 2014.

6. Business Area Wise Mapping—Business area wise mapping providesfunctionality by which user can retrieve mapping records that wereconfirmed or unconfirmed with respect to a particular business area.FIG. 59 is a screen shot 59 illustrating such a report 5902 generated bythe tool which shows details of forward disease classification codemappings in a specified business area. FIG. 60, in contrast, is a screenshot 60 illustrating a report 6002 generated by the tool which showsdetails of backward disease classification code mappings in a specifiedbusiness area that is different than that shown in FIG. 59.Illustratively, such reports may be exported using various differentformats (e.g., text, excel, and the like).

7. Versioning Report—Versioning reporting can illustratively provideeither code versioning or Mapping Versioning reports. A code versioningreport provides a user with a detailed analysis (in the form of piecharts, for example) about changes in parameters (such as a percentageof code added, deleted, and descriptions changed) between differentmapping set versions. FIG. 61 is an example screen shot 61 illustratinga code versioning report 6102 generated by the tool which shows acomparison of disease classification code modifications made betweendifferent disease classification code revisions. Such results can beshown for both diagnosis and procedure codes. To view these reports, auser enters a code type, a first version (such as “2009”) and a secondversion (such as “2011”). Accordingly, as shown in FIG. 61, two piecharts and are shown for diagnosis and procedure codes respectively,that illustrate data about the number of codes added, removed, anddescriptions changed in version 2011 from version 2009.

A mapping version tool provides a user with a detailed list of thechanges in the mappings made between selected versions. For example,referring to an example screen shot 62 in FIG. 62, a user interface 6202illustratively includes inputs for selection of an old version 6204,selection of a new version 6206, whether to include new mappings added6208, old mappings deleted 6210 and mappings changed 6212, selection ofdiagnosis code mapping 6214 or procedure code mapping 6216, and forwardor backward mapping 6218, and a show report button 6220. For example, asshown in the example screen shot 63 illustrated in FIG. 63, a user hasentered an old version “2009” in field 6204, a new version “2010” infield 6206, selected New Mappings Added 6208, Diagnosis Mapping 6214 andForward Mapping 6218. In response, the tool produces a list 6302 of allnew mappings added in the 2010 version which were not present in the2009 mapping version.

8. Customized Mapping—The customized mapping functionality produces areport of any customized mappings for a selected span of time. As shownin the example screen shot 64 illustrated in FIG. 64, a user interface4902′, which is similar in most respects to the user interface 4902illustrated in FIG. 49, illustratively further includes a “get allcustomized mapping” selection box 6402 which may be used to produce areport of all customized mapping made for backward or forward mappingsthat meet the remaining report criteria specified in the user interface4902′. In the example screen shot illustrated in FIG. 65, the user hasselected a “From date” of 7/1/2011 and a “To date” 7/20/2011 withrespect to forward mapping to retrieve a list of any customized mappingscreated in that selected time frame. An example of the resulting report6502 is shown in the example screen shot 65 illustrated in FIG. 65.

9. Published Mapping—The published mapping feature allows a user to viewa report displaying all the confirmed codes per business area.Specifically, an administrator may log in, and from the example screenshot 66 shown in FIG. 66, the administrator may select the business area“Enterprise”, for example. The administrator may select to viewconfirmed procedure codes or confirmed diagnosis codes in an adjacentdropdown menu, and by clicking on a view report button, a user can viewall confirmed ICD diagnosis code forward mappings for the Enterprisebusiness area. A user could view the same for backward mappings as well.An example report 6602 is shown in FIG. 66 for the Enterprise businessarea and for diagnosis codes.

10. Third Party Audit Trail Report—Referring to an example screen 67shot shown in FIG. 67, a third party audit trail report 6710 shows auditdetails of service consumption, such as which third party applicationconsumed the service, how many translations were done, and the like. Anallocator can view audit trail details of a selected user (medical code,approver, etc.). The user may specify a configuration of the report 6710by selecting a desired date range using date range fields 6704 and 6706,and by selecting “search” button 6708, all provided in a user interface6702. FIG. 68 is a screen shot 68 illustrating an example report 6802showing details of disease classification codes included in one suchaudit trail report generated by the graphic user interface of FIG. 67.

The reports to allocation page integration feature allows a user tointegrate a report with an allocation page for both types of GEMsmappings, and may be restricted to view by an allocator. The reportsintegrated with the allocation page include a mapping distributionreport for forward and backward mappings, a code distribution report forpayers, and a code distribution report for providers. Specifically, anallocator may login, navigate to the “Payer Data Analyzer” section, andclick on “Claim Code Distribution” for forward mappings. By selectingforward mapping 6904, backward mapping 6906, medical coder 6908 andapprover 6910 in a user interface 6902, and thereafter selecting“search” 6912, a report 6920 is generated of a corresponding ICD codelist common to the selected medical coder and approver. When a userwishes to view a report, an Allocate button 6930 will be selected andthe user will be redirected by the tool to a task allocation page withthe ICD-9 codes listed on the report 6920. A user can use thisfunctionality for a mapping distribution report and code distributionreport for a provider.

11. Expiry Mapping Details Report—The expiry mapping detailsfunctionality provides a user with a list of any code mappings that areexpired or are going to expire in a selected time period. As shown in anexample screen shot 70 in FIG. 70, a user can select in a user interface7002, for forward mapping 7004 or backward mapping 7006, a particularmonth in a drop down menu 7008 to view any subject reports for thatselected month. The user also has the option to select a date range(using fields 7010 and 7012) to view any qualifying reports, and asearch button 7014 is provided to cause the tool to generate the expiryreports. FIG. 71 is an example screen shot illustrating an exampleexpiry report 7020.

12. Work Flow Audit Trail Report—The Work Flow Audit Trail Reportdisplays any activities performed for a code mapping/translation. Forexample, as shown in the example screen shot 72 in FIG. 72, the report7202 lists details concerning a particular code and mappings related tothat code. FIG. 73 is an example screen shot 73 illustrating the tool'sfunctionality showing a report 7302 listing all codes' activities withina specified date range.

IV. Data Analytics

According to embodiments of the present disclosure the tool includes adata analytics feature which includes a Payer Data Analyzer feature anda Provider Data Analyzer feature.

A. Payer Analytics

The Payer Data Analytics feature of the tool analyzes healthcare payerdata and produces the follow reports relating to such analysis ofhealthcare payer data:

1. Upload claims

2. Claims Historical Data

3. Mapping Distribution Report

4. Claims Amount Distribution

5. Claims Conversion Distribution

6. Code Distribution

7. Provider Comparison

8. Claims Summary

9. Claim Audit Trail Report

1. Upload Claims—The upload claims feature provides forward mapping(ICD-9 to ICD-10) as well as backward mapping (ICD-10 to ICD-9)conversion for the uploading of processed medical claims. FIG. 74 is anexample screen shot 74 illustrating an upload claims user interface 7402for entering claims information. For forward claims processing, in theembodiment shown, a user can select radio button “ICD-9 Claims” 7404 andfor backward claims processing, a user can select “ICD-10 Claims” 7406.After browsing for the input claims data file and entering the file inthe dialog box 7408, including specifying a file description in a filedescription field 7410, the claims file can be processed by clicking a“Process Claims File” button 7412. After successful processing (i.e.,the forward or backward mapping) of the input claim file, the currentfiles (including success and error files) can be downloaded by clickingon the particular file link 7502 as shown in the example screen shot 75of FIG. 75. Alternatively or additionally, an error file may also bedownloaded by clicking on the error file link 7504. After processing theclaim files, an email is generated and sent to the all active users bythe administrator. A copy of the email is also sent to theadministrator.

An accepted format for the claims data can be retrieved and viewed byclicking on a claims format link. In the example shown, an acceptableformat for a forward mapping for payer claims contains informationincluding provider details, claim diagnosis and procedure codes, claimcharged amounts and paid amounts, and claim number. Examples showingpayer claims formats for forward and backward mapping inputs andcorresponding outputs can be found in the parent application, U.S.Patent Application Ser. No. 61/834,908, the disclosure of which has beenincorporated herein by reference in its entirety.

2. Claims Historical Data—FIG. 76 is an example screen 76 shot of a homepage for the claims historical data feature. Specifically, the toolperforms data analytics for both diagnosis and procedure codes. Forexample, via a user interface 7602, a user can select diagnosis 7604 orprocedure code 7606, enter an ICD-10 code (using a code lookup feature7610 if desired), select a particular business area, i.e., line ofbusiness (LOB) 7612 and State 7614, and generate the report by selecting“Search” 7616. With this feature, a user can view frequency analysisresults for a particular line of business (“LOB”) and within aparticular State, or for all input data that has been uploaded.

This feature can also provide a percentage of the use of a particularcode. As shown in an example screen shot 77 in FIG. 77, the toolproduces a graphic 7702 of the selected ICD-10 code and a report 7704 ofthe matching ICD-9 codes in historical claims data. The illustratedusage percentage in the claims historical data report 7704 can berepresented as the occurrence of a particular ICD-9 code related to aparticular ICD-10 code. Also, it provides a highlighted code 7706representing a reimbursement mapping code provided by CMS.

3. Mapping Distribution Report—The mapping distribution report providesa percentage of each type of mapping (e.g., one-to-one and one-to-manymapped codes) in the files uploaded in a batch process, for example.Referring to an example screen shot 78 shown in FIG. 78, a user selectsa file 7804 for which a mapping distribution is sought. The user canthen select a provider 7806, a code type diagnosis/procedure 7808 and aState 7810 for which a result is to be displayed. The user can thenclick the “View Report” button 7812 to view the resulting mappingdistribution report 7802 produced by the tool. The mapping distributionreport 7802 can be exported to different formats including but notlimited to XML, CSV, Acrobat Reader (.pdf), MHTML, Word, Excel, andTIFF.

4. Claims Amounts Distribution—The Claim Amount Report shows a claimamount distribution. Referring to an example screen shot 79 illustratedin FIG. 79, the report 7902 shows two pie charts: a “Total ChargedAmount for Claims” chart and a “Total Paid Amount for Claims” chart. The“Total Charged Amount for Claims” chart provides details about a totalcharged amount for claims by a selected provider in a selected state.The “Total Paid Amount for Claims” chart displays details about a totalpaid amount for claims for a particular provider in a particular state.Claim amount reports can be exported to different formats including butnot limited to XML, CSV, Acrobat Reader (pdf), MHTML, Word, Excel, andTIFF.

5. Claims Conversion Distribution Report—The claims conversiondistribution report gives details about all the mappings resulting froma successfully processed file. Referring to an example screen shot 80illustrated in FIG. 80, graphical representations for one-to-one,one-to-one clusters, one-to-many, one-to-many clusters, no mappings, andone-to-one clusters overflow are included in the example claimsconversion distribution report 8002. The claim conversion distributionreport 8002 can be exported to different formats like XML, CSV, AcrobatReader (pdf), MHTML, Word, Excel, and TIFF.

6. Claims Code Distribution Report—Referring to an example screen shot81 illustrated in FIG. 81, the illustrated claims code distributionreport 8102 shows details as per specific mapping type 8104 (i.e.one-to-one, one-to-one cluster, one-to-many, one-to-many cluster, nomappings and not found). This report also shows codes included in themapping. Claims code distribution reports can be exported to differentformats including but not limited to XML, CSV, Acrobat Reader (pdf),MHTML, Word, Excel, and TIFF.

7. Provider Comparison Report—The provider comparison report displaysmaximum and minimum one-to-one or non one-to-one mappings in aparticular state. The sort order decides the top and bottom fiveproviders which provide maximum one-to-one or non one-to-one mappings.

The provider comparison report tool provides reports according to threetypes: by codes, by claims, and by claims amount. Referring to anexample screen shot 82 illustrated in FIG. 82, a user can view maximumor minimum, one-to-one or non one-to-one mapped code, per provider for aparticular code. The example shown in FIG. 82 is for a minimumone-to-one mapped comparison between two providers. Referring to anexample screen shot 83 shown in FIG. 83, a provider comparison report byclaims 8302 can show a maximum or minimum, one-to-one or non one-to-onemapped claims report for different providers for a particular claim.

Referring now to an example screen shot 84 illustrated in FIG. 84, acomparison by claims amount report 8402 can show a maximum or minimum,one-to-one or non one-to-one mapped claims amount provided by differentproviders for a particular code. The example in FIG. 84 shows twocharts: a provider payment amount comparison chart, and a providercharge amount comparison chart. Specifically, the provider paymentamount comparison chart shows payment amount per provider. Likewise, theprovider charged amount comparison chart shows an amount charged by eachprovider.

8. Claims Summary—The Claims Summary report provides summary results ofall the files which are processed through a batch process. As shown inthe example screen shot 85 in FIG. 85, the tool lists information in thereport 8502 such as the total number of claims processed, totalsuccessfully processed claims, total charge amount($), total paymentamount($), top 50 providers processed claims, top 50 providerssuccessful claims, top 50 providers processed claims ($), top 50providers payment amount (percentage to top 50 providers chargeamount)$, total number of diagnosis codes, total number of procedurecodes, distinct diagnosis Codes, and distinct procedure codes.

9. Claims Audit Trail Report—The claims audit trail report provides adetailed description of claims requests for a given period of time. Auser can provide date ranges between which a result is desired. As shownin the example screen shot 86 in FIG. 86, this report 8604 isselectively produced based on information provided by a user via a userinterface 8602, and gives details like claim file name, total number ofclaims processed, total number of successful claims and total number oferror claims. As shown in FIG. 86, a user can click on one of theseaforementioned numbers, and a popup window may open showing a detailedlisting of all of the claims in that particular list. For example, asshown in a screen shot 87 illustrated in FIG. 87, a user has clicked ona total number of successfully processed claims in the report 8604 ofFIG. 86, and the resulting report 8702 produced by the tool shows alisting of the individual claims which are successfully processed. Whenthe user clicks on a particular errored claim, a popup will open whichwill show claims that were not processed. In each of these popups, atthe left hand side a “View Codes” link is provided, which, uponclicking, will display a list 8802 of the selected codes, an examplescreen shot 88 of which is shown in FIG. 88.

B. Provider Analytics

The Provider Data Analyzer tool operates similarly to the Payer DataAnalyzer tool, except its functionality is advantageous to providers inthat it provides information related to healthcare payer organizations.For example, this tool includes one or more of the following functionsand/or reports:

1. Upload claims

2. Claims Mapping Distribution

3. Payer Comparison

4. Claims Summary

5. Claim Audit Trail

1. Upload Claims—The upload claims feature provides forward mapping(ICD-9 to ICD-10) as well as backward mapping (ICD-10 to ICD-9)conversion for the uploading of medical claims. FIG. 89 is an examplescreen shot 89 illustrating an upload claims user interface 8902 forentering claims information. For forward claims processing, in theembodiment shown, a user can select radio button “ICD-9 Claims” 8904 andfor backward claims processing, a user can select “ICD-10 Claims” 8906.After browsing for the input claims data file and entering the file inthe dialog box 8908 (and/or using the browsing feature 8910), includingspecifying a file description in a file description field 8912, theclaims file can be processed by clicking a “Process Claims File” button8914. After successful processing (i.e., the forward or backwardmapping) of the input claim file, the current files (including successand error files) can be downloaded by clicking on the particular filelink 9002 as shown in the example screen shot 90 of FIG. 90.Alternatively or additionally, an error file may also be downloaded byclicking on the error file link 9004. After processing the claim files,an email is generated and sent to the all active users by theadministrator. A copy of the email is also sent to the administrator.

An accepted format for the claims data can be retrieved and viewed byclicking on a claims format link. An acceptable format for a forwardmapping for payer claims illustratively contains information includingthe following:

Provider details

Payer details

Claim Diagnosis and procedure codes

Claim charged and reimbursed amounts

Claim number

Hospital details

State Code

Admit Date

Discharge Date

Medicare Number

Medicaid Number

Health Plan Id

Type of Insurance

Net charge amount

Total amount

Similar to forward claims format, a provider claims backward input fileformat illustratively contains information including:

Provider details

Payer details

Claim Diagnosis and procedure codes

Claim charged and reimbursed amounts

Claim number

Hospital details

State Code

Admit Date

Discharge Date

Medicare Number

Medicaid Number

Health Plan Id

Type of Insurance

Net charge amount

Total amount

Co-insurance amount

Examples showing provider claims formats for forward and backwardmapping inputs and corresponding outputs can be found in the parentapplication, U.S. Patent Application Ser. No. 61/834,908, the disclosureof which has been incorporated herein by reference in its entirety.

2. Mapping Distribution Report—The mapping distribution report enables auser to understand various levels of distribution between the existingICD-9 codes received and their respective ICD-10 codes into differentcategories, such as one-to-one, one-to-one cluster, one-to-many mappedcodes, no map and not found. The mapping distribution report provides apercentage of each type of mapping (e.g., one-to-one and one-to-manymapped codes) in the files uploaded in a batch process, for example.

3. Paver Comparison Report—The payer comparison report provides maximumand minimum one-to-one or non one-to-one mappings in a particular state.The sort order decides the top and bottom five payer which providemaximum one-to-one or non one-to-one mappings. In one embodiment, thepayer comparison report tool provides three types of comparison reports:by codes, by claims, and by claims amount. A user can view maximum orminimum, one-to-one or non one-to-one mapped code, per provider bycodes. Referring to an example screen shot 91 illustrated in FIG. 91,the illustrated report 9102 shows a minimum one-to-one mapped comparisonamong three payers by code. Referring to an example screen shot 92 shownin FIG. 92, a payer comparison report by claims 9202 can show a maximumor minimum, one-to-one or non one-to-one mapped claims report fordifferent payers by claims. As shown in FIG. 92, the report 9202illustrates a one-to-one mapped comparison among three payers.

Referring now to an example screen shot 93 illustrated in FIG. 93, acomparison by claims amount report 9302 can show a maximum or minimum,one-to-one or non one-to-one mapped claims amount provided by differentproviders for a particular code. This example report 9302 shows twocharts: a payer reimbursed amount comparison chart, and a payer chargedamount comparison chart. Specifically, the payer reimbursed amountcomparison chart shows payment amount vs. payer. Likewise, the payercharged amount comparison chart shows a charged amount vs. payer.

4. Claims Summary—The claims summary report provides results of thefiles which are processed through the batch process. As shown in theexample screen shot 94 illustrated in FIG. 94, the claims summary report9402 provides information such as the total number of claims processed,total successfully processed claims, total charged amount, total paymentamount, top 50 providers processed claims, top 50 providers successfulclaims, top 50 providers processed claims, top 50 providers paymentamount (percentage to top 50 providers charge amount), total diagnosiscodes, total procedure codes, distinct diagnosis codes, and distinctprocedure codes.

5. Claims Audit Trail Report—This report is similar to the audit trailfunctionality referred to above with respect to FIGS. 86-88. The claimsaudit trail report provides a detailed description of claims requestsfor a given period of time. As shown in the example screen shot 95illustrated in FIG. 95, the claims audit trail report 9502 gives detailslike claim file name, number of claims processed, successful claims anderror claims, all based on information provided via a user interfacewhich may illustratively be identical or similar to the user interface8602 illustrated in FIG. 86. In any case, a user can click on a claimnumber within the report 9502 and a popup will open which will show theselected claim number.

Referring now to an example screen shot 96 illustrated in FIG. 96, whena user clicks on a particular successful claim, a popup window 9602shows claims that were successfully processed. When the user clicks onan errored claim, a popup window will open which will show detail aboutthe claims that were not successfully processed. In each of thesepopups, at the left hand side a “Views Codes” link is provided, which,upon clicking, will display a list 9702 of the selected codes, anexample screen shot 97 of which is shown in FIG. 97.

Referring to example screen shots 98 and 99 illustrated in FIGS. 98 and99 respectively, the reports to allocation page integration featureallows a user to integrate a report with an allocation page for bothtypes of GEMs mappings, and may be restricted to view by an allocator.The reports integrated with the allocation page include a mappingdistribution report for forward and backward mappings, a codedistribution report for payers, and a code distribution report forproviders. An example code distribution report 9802 for providers isillustrated in FIG. 98. When a user wishes to view a report, an Allocatebutton 9804 will be selected and the user will be redirected by the toolto a task allocation page with the ICD-9 codes listed on the report. Thereport is integrated with an allocation page include a mappingdistribution report for forward and backward mappings, a codedistribution report for payers, and a code distribution report forproviders. An example is illustrated in the screen shot 99 of FIG. 99.Specifically, an allocator may login, navigate to the “Payer DataAnalyzer” section, and click on “Claim Code Distribution” for forwardmappings. By selecting forward mapping 9904, backward mapping 9906,priority 9908, Search type 9910 and description 9912 in a user interface9902, and thereafter selecting “search” 9916, a report 9920 is generatedof a corresponding ICD code list common to the selected medical coderand approver, or all codes if the all codes button 9914 in the userinterface 9902 is selected. When a user wishes to view a specificreport, an Allocate button 9922 will be selected and the user will beredirected by the tool to a task allocation page with the ICD-9 codeslisted on the report 9920.

V. Searching

Embodiments of the present disclosure employ search functionalities, anexample of which is shown in the example screen shot 100 illustrated inFIG. 100. A search can be performed on both diagnosis 10004 as well ason procedure codes 10006. For example, a user can enter the descriptionkeyword “Tuberculoma” in the code description field 10008 for adiagnosis code 10004 and select the Search button

10010. All ICD-9 as well as ICD-10 codes whose description containingthe word “Tuberculoma” will be displayed. Another example using thedescription keyword “heart” is shown in the example screenshot 101illustrated in FIG. 101, which produces lists 10102 and 10104 of ICD-9and ICD-10 codes relating to the entered search term. It should be notedthat a search can also be performed by a tag associated with aparticular ICD code.

Using the linking of GEMs mapping from the Search Code functionality,when a code is selected, the system shows all mappings related to thatcode. In the example screen shot 102 illustrated in FIG. 102, the searchfeature includes a user interface 10202 which provides for selection offorward mapping 10204, backward mapping 10206 or reimbursement mapping10208, input into a field 10210 of an ICD-9 code (optionally using acode lookup feature 10212) and a “get equivalent ICD-10 code” button10214. Input of an ICD-9 code, e.g., 944.20 as illustrated in FIG. 102,the tool produces a graphic 10220 of the selected ICD-9 code and itstextual description, and a list 10230 of all ICD-10 codes correspondingto the specified ICD-9 code. Mapping histories of selected ICD-9 codesmay be selectively viewed using a “view mapping history” feature 10216of the user interface 10202. On the other hand, for backward mapping, ifa user may select an ICD-10 code, e.g., L02.511 as illustrated in thescreen shot 103 illustrated in FIG. 103, and the tool will then show agraphic 10320 of the selected ICD-10 code and its textual description,and a list 10330 of all ICD-9 codes corresponding to the specifiedICD-10 code.

VI. Workflow Management

According to embodiments of the present disclosure, the diseaseclassification code mapping tool includes an workflow management featurewhich is illustratively divided according to roles including: superadministrator, allocator, first and second level approvers, medicalcoder, and the like. These roles basically work on two modes: GEMs (allthe results are generated on the basis of GEMs files provided by CMS),and Specific mode (all the results are generated on the basis of codesprovided by the organization and both are isolated from each other).

The translator tool provides multiple levels of access for differentuser roles. For example, a user can access the system (or be restrictedto access) as one or more of the following types of users: superadministrator, administrator, allocator, first level approver, secondlevel approver or medical coder.

The super administrator can perform the following tasks: administration,configure, mapping, report, and search.

Referring to an example screen shot illustrated in FIG. 104, the mainmenu is shown in which the application mode 420 is selected to beSpecific and the business area is selected to be ICD-10. In this mode,the administration functionality allows a user (e.g., superadministrator) to create another user and assign that user with abusiness role (e.g., allocator, approver, medical coder and/or businessuser), and business areas that the new user can work in. As illustratedin FIG. 105, when the super administrator chooses to create a user, auser creation window 105 opens. For new user creation, the superadministrator enters the following details of the new user into a usercreation interface 10502: first name, last name, userId, password,confirm password, email ID, business role, and business area. The superadministrator further enters a business role of the new user into theinterface 10502, e.g., as an allocator, an approver (first or secondlevel), a medical coder or a business user. A user listing 10504 isillustratively provided via which the super administrator may editexisting user information.

Upon successful user creation, an account creation mail is automaticallygenerated and sent to administration by the super administrator. Theuser gets account details when the business area is allocated to him.Different email templates are sent based on the user roles. Similarly,if user information is updated (like active/inactive status is changed),the super administrator sends an email to the user regarding the updatein user's profile information.

As shown in the example screen shot 106 illustrated in FIG. 106, thesuper administrator can create or view a hierarchy by selecting thebuild hierarchy link 10602 located above the users list 10504. Ahierarchy refers to an organizational structure depicting therelationships between types of users (e.g., administrator, allocator,approver, medical coder, and the like). For example, as shown in theexample screen shot 107 illustrated in FIG. 107, the super administratorcan select a particular business area 10702 and an allocator 10704,which will provide list 10708 of approvers and medical coders associatedwith the selected allocator 10704 for the selected business area 10702.A similar user interface can be provided to allow the superadministrator to select first and second level approvers for selectedbusiness areas and corresponding assigned allocators.

When the hierarchy is successfully built, an allocation email isautomatically generated and sent to the users (e.g., allocated medicalcoders and approvers) by the super administrator. A copy is sent to theallocator as well.

The configure, mapping, report, and search features operate in a similarmanner as discussed above. For the specific functionality, the superadministrator may need to upload a specific codes file for which amapping is required. Respectively, these features will give results forspecific code files previously uploaded by the super administrator.

Allocator:

With respect to the approval workflow tool, an allocator can performtasks including one or more of: configure, task allocation, mapping,report, and search.

Configure—This functionality operates in a similar manner as discussedabove with respect to the super administrator.

Task Allocation—The allocator task allocation functionality may bedivided into four categories: (1) create task, (2) transfer task, (3)manage task, (4) and task status.

Create Task—Referring now to the example screen shot illustrated in FIG.108, an allocator can create a task in a task allocation menu 10802 toallocate codes to an approver and a medical coder for forward mapping10806 or backward mapping 10808 via a user interface 10804. Theallocator provides a type 10810, description code range 10812 orselecting an option referred to as “Get All Codes” 10816, and thenselecting “search” 10814. The allocator can then select particular codesto assign to an approver and medical coder from a resulting list ofICD-10 codes 10820 produced by the tool, and can further select anapprover 10840 and a medical coder 10850, with or without comments10830, relating to creating or modifying mappings for selected ICD-10codes. By clicking on “allocate” 10860, code mapping assignmentsrelating to the selected ICD-10 codes will be allocated to the selectedmedical coder and the selected approver. A list 10870 of approversassigned to selected ICD-10 codes may be produced by the tool.

Referring now to the example screen shot 109 illustrated in FIG. 109,for a specific mode, a priority option 10908 is provided in a userinterface 10902 for allocating tasks relating to forward 10904 orbackward 10906 mapping. The user interface 10902 may further include asearch type field 10910, a skill set field, e.g., heart, 10912, and asearch button 10914 as well as a “get all codes” button 10916. If a userwishes to allocate the codes according to a certain priority (e.g.highest, medium or low) this can be specified via appropriate selectionfrom the priority option menu 10908; otherwise the user can select “All”to get all codes.

Once the codes are allocated, an email is automatically generated andsent to the coder and approver by the super administrator. A copy isalso sent to the administrator and allocator.

Task Allocation—The allocator may allocate tasks by functional group,and a user interface 11002 for accomplishing this is illustrated in theexample screen shot 110 of FIG. 110. The user interface 11002 includesforward 11004 and backward 11006 mapping options, as well as a prioritymenu 11008, a search type menu 11010 and a functional group menu 11012.By selecting functional group as the search type, a functional group maybe specified from the menu 11012 to search, using the search button11014, for tasks to allocate to medical coders and/or approvers byfunctional group as illustrated in the example screen shot 111illustrated in FIG. 111. Optionally, the allocator can also select “getall codes” 11016 to retrieve all ICD codes associated with the selectedsearch parameters. Additionally, the allocator may assign groups ofcodes in one go by selecting the search button 11014 after selecting afunctional group, in which case the tool illustratively produces thegrid of codes 11202 which are related to the selected functional groupand which further illustratively includes an items per page pull-downmenu 11204. Illustratively, by default grid contains a modest number,e.g., 10, records per page. However, using the menu 11204, the allocatorcan select any number of ICD code records to display per page.Illustratively, the minimum number of records per page may be 10 and themaximum may be 500, although these values may be varied as desired. Inany case, the option to increase the number of ICD code records per pageallows the allocator to group large numbers of records together forallocation without having to manually advance through any, or fewer, ICDgrid pages. As described above, the allocator may then enter commentsrelating to task allocations in a comment field 11206, and may select anapprover using a pull-down menu 11208 and a medical coder using apull-down menu 11210. Additionally, as illustrated in the example screenshot 113 illustrated in FIG. 113, the grid of codes 11202 illustrated inFIG. 112 displays a grid of codes 11302 which includes an additionalfunctional group column which identifies various functional groupsassociated with each listed ICD-9 code.

When ICD codes are uploaded by functional groups as just described,there may be cases where the ICD codes can be common across differentfunctional groups. Illustrated in the screen shot 114 of FIG. 114 is anexample list of such overlapping codes identified in a particularfunctional group. The tool illustratively includes functionality tore-allocate such ICD codes into the workflow for the differentfunctional group and run the workflow. In one embodiment, the firstassignment of a code in overlapping functional groups to a medical coderwill identify the medical coder that performs the mapping, and thesecond assignment will identify another medical coder that has onlyviewing privileges for the mappings but not editing privileges. The samewill be applicable as between an assigned approver level 1 and anassigned approver level 2. In either case, the medical coders andapprovers will illustratively have 2 grids displayed; one with codes tobe mapped by the medical coder, and the other with codes allocated toanother medical coder for mapping but viewable by the first medicalcoder. The same hierarchy is illustratively implemented with respect toapprover levels 1 and 2. In any case, once and code is allocated, anemail is automatically generated and sent to the medical coder andapprover by a super administrator, and a copy is also sent to theadministration and allocator. An example of such an email 11502 is shownin the example screen shot 115 illustrated in FIG. 115. In theillustrated example, the email 11502 illustratively includes a table ofcode assignments 11504.

Transfer Task—The allocator can reallocate, or transfer, codes for amedical coder or an approver. Specifically, to pull a task from amedical coder or an approver, the allocator can select a business area,and select the medical coder or the approver whose tasks the allocatorwants to reallocate to other resources.

Referring now to the example screen shot 116 illustrated in FIG. 116,the allocator may select particular codes and assign them, for forward11604 or backward 11606 mapping, to a medical coder 11610 or approver11612 in a selected business area 11608, via a user interface 11602. Inthe illustrated example, a medical coder 11610 is selected for the tasktransfer, and the tool accordingly modifies the user interface 11602 toproduce a medical coder pull down menu 11614 which may be used to selecta desired medical coder whose current code mapping assignments are to beviewed, one or more of which may be transferred to another medicalcoder. When the “get task” button 11616 is selected, the tool producesthe corresponding list 11620 of codes, and the allocator can select themapping task of one or more codes from the list 11620 to transfer, e.g.,with or without comments 11630, to another medical coder which may beselected using the pull down menu 11640. By clicking on “Transfer Task”11650, selected codes will be re allocated to the selected medical coderor approver or to an already assigned approver. The tool can also serveto prevent a medical coder and approver from being the same for a singlecode or task.

When the task is reallocated, an email is automatically generated. Theemail is sent to approve a medical coder to whom the task is reallocatedfrom the administrator. A copy of an email is also sent to the allocatorand the administrator.

Manage Task—An allocator can also manage tasks. For example, as shown inthe example screen shot 117 illustrated in FIG. 117, the allocator canunconfirm particular mappings, e.g., forward 11704 or backward 11706mappings, before their end date via a user interface 11702. Theallocator or other user, e.g., administrator, can search the mapping bycode, by description, or can search for all mappings through pull downmenu 11710. Selecting “search” 11712 will produce a list 11720 ofcorresponding ICD codes. If the “Get All” option is selected, allmappings will be displayed in the list 11720. The allocator can thenselectively unconfirm a mapping by clicking the “unconfirm” button,e.g., 11722, adjacent to the code in the list 11720. Upon making theunconfirm selection, the allocator may be prompted to specify the reasonfor unconfirming the code.

After a user unconfirms any mapping, an email is automatically generatedand sent to the allocator, approver and medical coder who have done thisparticular mapping. A copy is also sent to the administrator. A copy ofthe email may also be marked to the business user for the department.

Task Status—FIG. 118 is an example screen shot 118 of a process by whichan allocator can retrieve a task status. In some embodiments, byselecting a particular department, the allocator can get a task's statusreport. In this example, a user interface 11802 includes selections11804 and 11806 for ICD-9 and ICD-10 diagnosis codes respectively, anallocator selection menu 11808, a business area selection menu 11810 anda “get report” button 11812. The tool illustratively produces threereports from which the allocator can choose: a coder wise report 11820,an approver wise report 11830 and a client approver wise report 11840.These reports contain information including the medical coder/approvername, number of codes assigned, number of codes approved, number ofpending codes to process, number of rejected codes, and number of codespending approval. By clicking on the corresponding numbers, an allocatorcan get a more detailed report as shown in the report 11902 illustratedin the example screen shot 119 of FIG. 119.

Mapping, Report, and Search—The mapping, report, and search featuresoperate in a similar manner as discussed above. For the specific codeoption, the super administrator may need to upload a specific codes filefor which a mapping is required. Respectively, these features will giveresults for specific code files previously uploaded by the superadministrator.

Medical Coder Tasks:

With respect to medical coders, allocators can perform tasks including:work list, report, and search.

Work List—Referring now to the example screen shot 120 illustrated inFIG. 120, the work list tool is divided into three parts: work list1904, pending list 12006, and rejected list 12008 for a selected mappingtype 12002. The work list feature produces a list 12010 of details aboutnumbers of the assigned codes to be processed. As soon as any code isprocessed, it will be dropped into the “pending list.”

Pending List—Referring to the example screen shot 121 illustrated inFIG. 121, the pending list 12102 provides details about any codesprocessed by a medical coder that are awaiting approval.

Rejected List—Referring to the example screen shot 122 illustrated inFIG. 122, the rejected list 12202 provides gives details about all thecodes that have been rejected by the approver.

Escalated List—If the medical coder is assigned a code that is outsideof the medical coder's expertise, the medical coder can escalate thatcode to an approver to reassign to another medical coder.

Approver—level 1:

With respect to the approval workflow, an approver can perform tasksincluding: work list, report, and search. The work list feature isdivided into four parts: pending list, approved list, escalated list,and completed work list.

Escalated List—Referring now to the example screen shot 123 illustratedin FIG. 123, the approver worklist includes a pending list 12304, anapproved list 12306, an escalated list 12308 and a rejected list 12310,all for a selected mapping type 12302. In the example illustrated inFIG. 123, the Escalated List 12308 is selected, and the tool produces acorresponding escalated list 12320 adjacent to the worklist. Theescalated list includes a functional group pull down menu 12330 viawhich the approver can select a desired functional group. Once selected,the escalated list 12320 contains details about all of the codes whichare assigned to another medical coder. The approver can click on ahyperlink of a code in the list 12320, and this action illustrativelyproduces the text box 12402 illustrated in the example screen shot 124of FIG. 124. Using this text box 12402, the approver can select analternate medical coder 12406 to whom to reassign the selected code,with or without providing a written reason 12404, and by clicking the“reassign” button 12408 the task in the escalated list 12320 isreassigned to the selected medical coder. Optionally, the approver canupload a reference document 12410 relating to the reassigned code.

Rejected List—Referring now to FIG. 125, an example screen shot 125 ofthe approver worklist is shown in which the Rejected list 12310 optionis selected, producing the rejected list 12502. By selecting afunctional group using the pull down menu 12330, the rejected list 12502contains details about all of the codes having a mapping that has beenrejected. The approver level 1 can select a correct mapping and thensave the correct mapping. By so doing, the tool will automatically movethe formerly rejected code to the approved list 12602 as illustrated inthe example screen shot 126 illustrated in FIG. 126.

Approved List—Referring now to the example screen shot 127 illustratedin FIG. 127, the approved list available to the approver level 1includes details about all of the codes which are assigned to theapprover level 2, and an example of such a list of codes 12710 is shownin FIG. 127. The second level approver worklist includes a work list12704 and a completed list 12706, for all assigned forward and reversedmappings 12702. The codes in the list of codes 12710 in the approverlevel 2 worklist move to the completed work list 12706 upon approval bythe approver level 2. After approving, the code is removed from theapproved list of the approver level 1.

Pending List—Referring now to the example screen shot 128 illustrated inFIG. 128, the approver pending list 12802 is shown for a selectedmapping type 12302 and for a selected functional group 12330. Thepending list 12802 gives details about all the codes that are pendingfor approval. The approver can approve or reject each of the mappings byclicking on the appropriate approve/reject button. Illustratively, thetool may include a feature by which the approver can select and approvea plurality of records at a time, e.g., 10 records, by clicking the“Approve All” button 12804. After approving or rejecting any code, anemail is automatically generated and sent to the medical coder to whomwas given the task from the administrator. A copy is also sent to theadministrator and his allocator.

Approver—level 2:

With respect to the approval workflow, an approver level 2 can performtasks including: work list, report, and completed list.

Work List—Referring to the example screen shot 129 illustrated in FIG.129, an approver level 2 worklist includes a Work List 12704 and aComplete list 12706 for each mapping type 12702. An example Work List12902 is shown in FIG. 129 for a selected functional group 12330, andthe list 12902 is a list of all mappings that are approved by a level 1approver for the selected functional group.

Complete List—Referring now to the example screen shot 130 illustratedin FIG. 30 an example Complete List 13002 is shown for a selectedfunctional group 12330. The Complete List 13002 provides a list of allmappings that are approved by a level 1 approver and confirmed by allapprovers from the selected business area.

With respect to an iteration cycle in workflow, an approver can reject acode a specified number of times (e.g. three). At that point, theapprover will have to map the code and confirm the mapping (i.e., therejection option would be disabled). Specifically, referring now to theexample screen shot 131 illustrated in FIG. 131, an approver could loginand attempt to reject the same code in a pending list 13102 more thanthree times. Consequently, the approver will get an error messageproduced by the tool indicating that the approver cannot reject amapping more than three times. The approver may then select the approveall button 13104 to approve all such codes or approve each such codeindividually by selecting the code and clicking the approve button.

Report and Search

The report and search features operate in a similar manner as discussedabove. For specific mode, the super administrator may need to upload aspecific codes file for which a mapping is required. Respectively, thesefeatures will give results for specific code files previously uploadedby the super administrator.

Future Mappings

According to embodiments of the present disclosure, referring now toexample screen shots 132 and 133 illustrated in FIGS. 132 and 133respectively, the tool illustratively allows a user to reallocate orconfirm code that is already confirmed within the same department, butwith a different effective date. In other words, the tool allows usersto set mappings that will only become effective at a future date. A userinterface 13202 is provided via which the user may select an ICD-9 codeof a specified code type, and then select “get equivalent ICD-10 code.”A graphic 13220 of the selected ICD-9 code and its textual descriptionare provided, as well as a table 13230 of mapped ICD-10 codes. A colorcode table 13240 is illustratively included to distinguish betweenICD-10 codes having similar forward and backward mappings (e.g., rows inthe ICD-10 table shaded yellow) and ICD-10 codes having differentforward and backward mappings (e.g., rows in the ICD-10 table shadedgreen). A future mappings list 13250 is also shown which lists ICD-10codes which are already confirmed within the same department.

Multiple Confirmations of Code—This feature allows a user to allocate acode which is already confirmed. The code can again be assigned throughthe workflow for mapping and future confirmations. Using this feature, auser can have an ICD-9 code mapping to different ICD-10 codes fordifferent spans of time. For example, an ICD-9 code “014.80” maps to anICD-10 code of “A18.32” or “A18.39.” During the initial workflow, it wasconfirmed that the ICD-9 code “014.80” maps to an ICD-10 code “A18.32”from the date Mar. 30, 2012 to Jun. 30, 2012. Then however, the user canrun the workflow over again anytime before Jun. 30, 2012 and fix afuture map for the ICD-9 code “014.30” before the mapping expires. Inthe example screen shot 133 illustrated in FIG. 133, the future mappinglist 13302 lists ICD-10 codes which are confirmed in the same departmentbut which have different effect dates, e.g., 3/31/2012-6/30/1012 and7/1/2012-7/22/2012 for the same code A18.32. The tool illustratively hasvalidation to avoid such overlapping dates.

Referring to the example screen shot 134 illustrated in FIG. 134, anallocator can login, go to task allocation, create task, and select anICD code 13404, 13406, 13408, 13410 from a user interface 13402 andselect “get mappings” 13412, and list of codes 13420 is produced, one ormore of which may be assigned to the medical coder. Then the medicalcoder can go to the work list, and click on the assigned ICD code. Themedical coder can then work on that task, do the appropriate mapping,and save the mapping with a justification. This will send the task(e.g., the ICD code) to the approver. Now, referring now to the examplescreen shot 135 illustrated in FIG. 135, an approver can login by and goto the work list and approve the same task with certain effective dates.The allocator can login to see a list 13502 with the same code that theapprover had just approved, and subsequently confirm the code withdifferent effective start and end dates.

Coder Support Documents—This feature allows a coder and an approver toupload a reference document which has been referenced while codemapping. Also, the user can view the document by downloading thereference document.

A user can login as a medical coder and go to the work list, click onany code. The tool will redirect the coder to the mapping page, wherethe coder can click on “save” after selection of an appropriate mapping.Referring to the example screen shot 136 illustrated in FIG. 136, apopup window 13602 illustratively appears with a reason field 13604 anda save button 13606. Illustratively, the user can click on the “UploadReference Document” button 13608 to upload the document. Referring nowto the screen shot 137 illustrated in FIG. 137 a list 13702 is displaywhich contains links to all uploaded reference documents. The user candownload any document in the list 13702 by clicking on a correspondingView/Download link.

The report and search feature operate in a similar manner as discussedabove. For “Specific”, the super administrator may need to upload aspecific codes file for which a mapping is required. Respectively, thesefeatures will give results for “Specific” code files previously uploadedby the super administrator.

Reverse Map—While defining forward mappings, the backward mappingsleading to the source ICD-9 code are illustratively visible, so that auser can analyze and confirm the forward mappings within the tool. Thesame applies while defining backward mappings. Referring to an examplescreen shot 138 illustrated in FIG. 138, a user can fetch all the ICD-10codes which map to the ICD-9 codes originally entered by the users byquerying the backward mapping table for codes. The code entered on thebelow screen is a “no map” code in the forward direction. However, withrespect to the backward mapping a different result is given. Forexample, the ICD-10 codes in the list 13802 are the list of codes(ICD-10 codes) which map to 707.21. This gives the user guidance inselecting the appropriate mapping.

VII. New Mappings

Embodiments of the present disclosure allow the disease classificationcode mapping tool to create new mappings for different business areas.Specifically, referring now to example screen shots 139 and 140illustrated in FIGS. 139 and 140 respectively, an administrator maylogin, select GEMs application mode 420, and select the “Claims”business area 430, for example. The user may then go to the mappingsection and enter an ICD-9 code and click on the “get equivalent ICD-10button. A custom mapping link may be provided which produces a page14002 which can be used to change the mapping to a different businessarea. Now, by going back to the home page and selecting “CareAdministration”, for example, as a business area, a user can check thesame mapping in the mapping section which the user recently changed. Theuser will be able to see the older mapping as a new mapping alreadysaved for the different business area. Now, by selecting specific as amode, and “Claims” as the business area, the user can check the samemapping in the mapping section that they have just changed.Consequently, the user can see the older mapping as the new mapping thatis already saved for different modes.

Claims Data Analyzer for Specific Mode—Payer as well as provider claimscan be uploaded on the basis of specific mode (i.e., theclient/organization specific mode). This is shown in the example screenshot 141 of the upload claims screen illustrated in FIG. 141 whichincludes a user interface 14102 having an ICD-9 claims selection button14104, an ICD-10 claims selection button 14106, an input claims filedialog box 14108 (optionally including a browsing feature 14110), a filedescription field 14112 and a “process claim file” button 14114.

Upload Section/Ranges and Get Base Mappings—This feature may berestricted to use in GEMs mode. It allows the user to upload the filewhich contains the ICD-9 code or ranges, and give the base mapping forindividual codes as the output file. FIG. 142 is an example screen shot142 illustrating one embodiment of such an input file 14202.

FIG. 143 is an example screen shot 143 illustrating a user interface14302 from which a user can upload the input file. The user interfaceillustratively includes ICD-9 diagnosis and procedure code selectionbuttons 14304 and 14306 respectively, an ICD file selection field 14308(with optional browsing button 14310), a file description field 14312and a “submit” button 14314. A download file is illustrativelyidentified with a link 14320 via which the file may be downloaded.

VIII. Code List Conversion and Financial Neutrality

This feature contains many functionalities including, but not limitedto, the following:

-   -   Upload specific code    -   Convert code list to code range for ICD-10 codes    -   Code range input to Task allocation    -   Allowing access to business user to look up mappings for        particular code    -   Display Financial Neutrality (FN) average variance for        Individual codes on Mapping Screen    -   Translator to accept a list of codes and return the translations        for the same    -   Translator should accept the customer defined formats for        translation: Benefit Migration    -   Listing of Menu on role wise access and deciding proper menu        names and proper access

Embodiments of the present disclosure allow a user to upload an ICD-10code list, and will give the different ranges as an output file. FIGS.144 and 145 are example screen shots 144 and 145 respectively of sampleinput and output files respectively. As shown in an example screen shot146 illustrated in FIG. 146, a user can login as an administrator, go tothe user interface 14602 and enter ICD-10 diagnosis 14604 or ICD-10procedure 14606, select an ICD-10 code input file 146-08 (with orwithout an optional browsing feature 14610), and click on ICD-10 coderanges 14612 to select an ICD-10 code range file to upload.

Code Range Input to Task Allocation—This feature allows an allocator tosearch codes for allocation by entering an input code range. Anallocator may log in, go to the task allocation section, and click oncreate task. Referring to the example screen shot 147 illustrated inFIG. 147, the user can select the search type forward mapping 14704 orbackward mapping 1470 from a user interface 14702, and further select asearch type from a pull down menu 14708 and a code range from a pulldown menu 14710, and click on “search” 14712 to search codes forallocation by input code range. Illustratively, the user interface 14702may include a “get all codes” button 14714 for retrieving all codes ofthe given search type.

Allowing Access to a Business User to Look Up Mappings for ParticularCode—FIGS. 148 and 149 are example screen shots 148 and 149 respectivelyof a read only mapping and search menu for a business user with readonly access. From the search menu 10202, the searched codes 10220 willbe redirected to the mapping screen 14802 if clicked on any code in viewonly format. Specifically, a business user may login, go to the mappingsection, and click on the GEMs mapping. This will show a read onlymapping screen (see FIG. 149). By navigating to the search section 14902for a diagnosis 14904 or procedure code 14906, entering a codedescription into the description field 14908 and clicking on the“search” button 14910, the user will be presented with display codedetails in a list 14920 of ICD-9 codes and a list 14930 of ICD-10display codes. Clicking on any code will redirect the user to themapping screen in read-only (or view) mode.

Display Financial Neutrality (FN) Average Variance for IndividualCodes—This feature allows a user to calculate an average variance forindividual codes. For example, referring to FIGS. 150 and 151 a user maylogin as an administrator, navigate to the configure section 15702,select an ICD-10 file (with or without an optional browsing feature15106), select a file description 15108 and click on the “submit” button15110. FIG. 150 is a screenshot 150 of a sample input file for thefinancial neutrality feeds.

Roles Based Security—This feature allows a user to view a particularfunctionality on the basis of their roles. For example, a user can loginas an administrator, go to the administration section, click on createuser page, and note the complete URL of this page. Consider if anallocator, for example, pasted the same URL which was copied earlier inthe browser. This will redirect the user to a custom error page.

While the disclosure has been illustrated and described in detail in thedrawings and foregoing description, such an illustration and descriptionis to be considered as exemplary and not restrictive in character, itbeing understood that only illustrative embodiments have been shown anddescribed and that all changes and modifications consistent with thedisclosure and recited claims are desired to be protected.

What is claimed is:
 1. A computerized method for translating healthcarecodes from a first healthcare classification system to a secondhealthcare classification system, the method comprising: receiving afirst plurality of healthcare codes associated with the first healthcareclassification system; receiving a second plurality of healthcare codesassociated with the second healthcare classification system; and mappingat least one of the first plurality to at least one of the secondplurality according to user-defined parameters.
 2. The computerizedmethod of claim 1, further comprising: mapping at least one of thesecond plurality of healthcare codes to at least one of the firstplurality of healthcare codes.
 3. The computerized method of claim 1,wherein the mapping is based on a general equivalence mapping (“GEM”).4. The computerized method of claim 1, further comprising: classifyingthe mapped at least one of the first plurality of healthcare codes to atleast one of the second plurality of health care codes.
 5. Thecomputerized method of claim 1, further comprising: restricting use ofat least one of first and second plurality based on a type of user. 6.The computerized method of claim 1, further comprising: converting themapped at least one of the first plurality of healthcare codes to atleast one of the second plurality of healthcare codes.
 7. Thecomputerized method of claim 1, further comprising: converting themapped at least one of the first plurality of healthcare codes to atleast one of the second plurality of healthcare codes in accordance. 8.The computerized method of claim 1, further comprising restrictingconversion of a mapping to authorized users.
 9. A system, comprising:one or more computing devices including: a memory having program codestored therein; and a processor in communication with the memory forcarrying out instructions in accordance with the stored program code,wherein the program code, when executed by the processor, causes theprocessor to perform steps comprising: receiving a first plurality ofhealthcare codes associated with the first healthcare classificationsystem; receiving a second plurality of healthcare codes associated withthe second healthcare classification system; and mapping at least one ofthe first plurality to at least one of the second plurality according touser-defined parameters.
 10. The system of claim 9, wherein theprocessor comprises the additional step of: mapping at least one of thesecond plurality of healthcare codes to at least one of the firstplurality of healthcare codes.
 11. The system of claim 9, wherein themapping is based on a general equivalence mapping (“GEM”).
 12. Thesystem of claim 9, wherein the processor performs the additional stepof: classifying the mapped at least one of the first plurality ofhealthcare codes to at least one of the second plurality of health carecodes.
 13. The system of claim 9, wherein the processor performs theadditional step of: restricting use of at least one of first and secondplurality based on a type of user.
 14. The system of claim 9, whereinthe processor performs the additional step of: converting the mapped atleast one of the first plurality of healthcare codes to at least one ofthe second plurality of healthcare codes.
 15. The system of claim 19,wherein the processor performs the additional step of: converting themapped at least one of the first plurality of healthcare codes to atleast one of the second plurality of healthcare codes in accordance. 16.The system of claim 9, wherein the processor performs the additionalstep of: comprising restricting conversion of a mapping to authorizedusers.
 17. A computer program product comprising non-transitory computerreadable medium further comprising: code for receiving a first pluralityof healthcare codes associated with the first healthcare classificationsystem; code for receiving a second plurality of healthcare codesassociated with the second healthcare classification system; and codefor mapping at least one of the first plurality to at least one of thesecond plurality according to user-defined parameters.
 18. The productof claim 17, wherein the mapping is based on a general equivalencemapping (“GEM”).
 19. The product of claim 17, wherein the non-transitorycomputer readable medium comprises: code for classifying the mapped atleast one of the first plurality of healthcare codes to at least one ofthe second plurality of health care codes.
 20. The product of claim 17,wherein the non-transitory computer readable medium comprises: code forconverting the mapped at least one of the first plurality of healthcarecodes to at least one of the second plurality of healthcare codes.